FIEUREI4

l. \\trat does the round radiolucentarea in

this radiographrepresent?
l. \\Trat could it be misdiagnosedas?

I _5
FIEURE
The L'rrrder .'lf w ha: entill is indicatedby the
arrou's l

FIOURE
I_6
The arron: ::e pqr[11ingat u'hat commonly
recognized :::-.1;xures .r
area in ffimft-7
mhsn the dentist wishesto seethis structure,
t tufur.-ra-vexposure should be decreased.What
M rffifustructure?

by the mt-8
ffiumiry,
1is commonly found in the wall of entity
A Fnri'Lv 3 is often seen outlining entity 2.
ffimifrr,4linesentity 3.
!{[amnethe entities indicated in this radiograph.

mnly
mr -9
Tllhmries of the maxillary tuberosity area nor-
rm@" cr:,nteinswhat entities?
 ;peIIeJ,{pcelocur seullauros
ll sr leqa pu? ,{Jer.upueleql Jo etlIeu eql sr
leqla'peuDuepr,{pce;rocur,{lpuorsecJo sr l€ql
>IJ€rrrpuel
f-telpxeru e o1Burlurodsr A\orre oLIJ
8l-t iln\H
'qderB
-orper slql q peleJrpursernlcruts eql fJrluepl
tt-t iln1H
;1e lurod s,/y\otreeql op ]eql11
9t-t iln,H
http://dentalbooks-drbassam.blogspot.com/
 [n radiograph A, the zygomatic arch is seen at
:me top of the picture. In radiograph B, the A
goffiatic arch is seen in the middle right of
31*
:me picture. Explain the differences in these
tffirq.lrffikns.

s radio-

F,,ffiURE
I -20
What anatomic landmarks does this view of an
edentulous patient demonstrate ?

lmark
lVhat
iis it
 \-
01
;eare
i':'-'"tqJprlliltrJsrqlJo JelueJ aql uI .iruacnl
i- '-?:L. au: snlBr{^t\.auoqaqlJo JalueJ eql
ri" :nbrdtnrFEJ punoJ 3r{} pu€ ( 1) ,{Jl1uepr
: tuttrF tr.t'ltri uaq44 'rc SuDIoo[ eJ,no/^
;;i: \IItuapI ol sl op ol Sult{l lsJg eqJ
tz- I iln,H
ia8prr eql
eq} sI ]€qa
ia-nraql uo ueas.,{cuacnlolp€J
zz- I #n,H
6s{JeuIpuel
o,ry\] aql eJe leqlA
tz-t iln,H
 ffimrmil-24
tuh,u doesthe radiolucency at the apex of
;illmitm; pn'emolarrepresent?
" T*h;,aIdoes the radiolucent area apical to
illilHiirm inolar represent?

mil-25
WIM nre the vertical radiolucent lines viewed
rNm
ttrffims
radiograph?

rffiil-26
L|lldm,lr'lnirii
rhe structures indicated bV the arrows.

1l

a'.,.
ill

FIGURE
I-27
Namethe structuresindicatedbv the arrows.

FIGURE
I_28
Beginningat the top, list the areasindicated by
the arrows.

FIGUREI _29
The arrows are pointing at an anatomic struc-
ture that is not usually seen on a periapical
radiograph. What is this structure?

12
 0cclusal Anatomy
'illrunl,,trrtt'a

rJo
{flilffill{mE
li'riirumrc
-.:i structures indicated by the affows
ililltr!(:r
lnxxm:€rs.What radiographic view is this?

il-3t
-lffiF/llmF
lilruuiur.c
!e structures indicated by the arrows
Lutmd
rrLiurbers.What is this radiographic view?

t3
 AnatomY
NormalPanoramic

I-3'2
FrcURE
Name the structures indicated hf--the numbers and the numbered alrows'

FIGURE
I-33
Nrme the structures indicated bv the numbers and numbered arrows.

14
 AnatomY
ilnmaI Extraoral

FIGURE
l-U LateralViewof theSkull
Name the structures indicated by the numbers and numbered arrows.

l5
 | -35
FIGIIRE the Skull
':stero-AnteriorViewof
Identifl' the structuresindicatedby the numbersand numberedarrows'

16
 FIGURE | -37 Submentovertex Viewof the Skull
I jentify the structuresindicatedby the numbersand numberedarrows.
'.\-:i doesstructureNo. 17not show?

18
Film
Exposure
and
Processing
Errors

19

&
 ErrorsandArtifacts
uliltfft"r'lilcrts
r , : -.:;r to the following tables in the an-
'rrr
" ,:
tttLlL'l i
- --rrO
ri' .;,ral projectionor techniqueerrors
ttt't'ul exposureandmanualprocessing
,,,"rj,o,io
r;*tetrrr?ticprocessor trouble-shooting

irillilnJumg
2- t
\*rr'"',.,-
: ,e1urexplanationof the radiolucency
,,'mLnlr-
fl:Jtr1 in the cervical area of the maxil-
LLrLrrt'
:r: ne and first premolar teeth? What
{l " -:[:
llliiiillluh .r

{fiflrulm
?-2
rrtl*rtLr'rri.r.
,:::u. coined by Dr. David F. Mitchell of
mnrrd;,iifi,sJniversity School of Dentistry, de-
riiliil'rfr:rllrr.i
-:le film-handline error seen in this ra-
LLiiiiturl'rrrfrr:r
I

U,

fliilmutffi2-3
i'r*':.:erposureerror was madehere?
- ,:;nttifv the two small radiopaquespots
,i,rrrul,;y,,n
II:his film.

21
 FIOURE2_4
Whatfilm-handlingerror wasmadehere?

FIEURE2_5
Why do the roots of the premolar teeth appear
"fuzzed out"?

FIGURE
2-6
Name two possiblecausesfor the inadequate
periapical coverage.
 et,.'

mmI-/
frilnwr:$rrrI "hlank" image such as this be pro-
I
hllllillrrrrr[rrrrrlldir

)4
a

m2J
ffillilmcnnasureerror or errors may have been
|Illilrufu
hffiel

m2r-9
1,,Mrusm m-ouldyou describe the overall ap-
0uluilwm/ffof-this radiograph?
1, ffii,lrn this occur?
-Joes

23
FIGURE
2-IO
What processingsolution can produce the arti-
fact seen at the apex of the mandibular first
molar?

FIGURE2-I I
Whatfilm-handlingerror wasmadehere?

FIGURE
2-12
l. What exposureerror was made?
2. What was the cause?
 2-t3
ffim-handlingerror was made here?

2-14
processingsolution may produce this ar-

2-t5
tell us what exposure effor was made

25

p
 FIGURE
2_16

FIGURE
2_18
Can you name two film errors evident in this
radiograph?Yes, you can. Try.

26
ffim3-19
*'r-;nu.5ure error has been made here?
'lflffilllllltilttttut
llffimw'
f

tw2-m
wrne reasonswhy this film is too light.
lllll[unnnm

w2-21
; what anatomic structure is superimposed
entke crown and root of the maxillary
,rifiwur'lffirs
fi|llltru "
L E: a 'lid this superimpositionoccur?

27
 2-22
FIGURE

F//GURE2-23
|
Whatdo you suppose producedthehorizonta
blackline acrossthe crownsof the maxillary
teeth in this radiographdevelopedby autol
maticfilm-processingmethods?
]

FIEURE 2_24
Givea commentary on the whiteline seenin
the lower right-handcornerof this film.
 reasonswhy this film is too dark.

I error was made?How?

ffimhandling error produced this

artifact over the secondmolar?

29

a
 FIGURE2_28
Whatfilm-handling
errorwasmade?

FIGURE
2_29
Why were the apicesof the secondand thir;
maxillary molarsmissed?

FIGURE
2_30
What processingerror was made?(Clinicall
the film lookeda little greenish.)
 reasonswhy this film wasfogged.

y,uur differential diagnosis of the condi-

mrcpresented by the radiopaqueportion of
ical radiolucencyseenin this radio-
lnclude possibleartifacts.

31
 FIGURE
2_33
The radiopaque circular areas in these
radiographsare all of different origins. What
your list of possiblecausesof theseopaciti
(arrows)?

32
ffiBffit-34
-nr-proces
'.Iff{llllfiutr'f, singartifactis presenthere?

mmff 2-35
ninpened to this film?
'lffillhur

immmzJ6
, ]fi bat anatomic structure superimposed
rumil&uranillary antrum is causingthe sinus to
;[t-rudy,as if fluid-filled?
umfipffirr-
,1 "h"ratexposureerror producedthis effect?

33
 2_37
FIGURE
This radiographwas processedin solutionsat
90"F; the film was then rinsed under the cold-
water tap. Give the term for what happensto
the emulsionwhen this film-processingerror is
made.

2_38
FIEURE
This film was correctly exposed.The upper
dark area looked greenishclinically. Name or
describetwo manualprocessingerrorsthat oc-
curred.

FIEURE2_39
What artifact, which mimics enamal hypopla-
sia, is'presentin this radiographof deciduous
teeth?

34
 ,flltiilHdm3-40
""illlilm
"rr-:,;r seenon this radiographresembles
illtLt
ir;ilLL]rtit,:
tract. What is this artifact?

,ffilltrlliffiS2-4/
rrthrlh'.1 ln-handling or processing errors
,,ttl,,l,,ulin:-[
- :efe ?

)w[lw"2-42
'\ll[tlll\ru
:nFr-rSure error occurred here? Hint:
* :::;rirlltr:;iiaS
device was used.

35
 FIEURE2_43
Films A and B came from the same double
packet. Film A's image,however,differs from
that of Film B. What error or artifact-if any-
affectingFilm A would accountfor this?
1. Fixer artifact
;a . 2. Developerartifact
3. Scratchedemulsion
4. There is neither an error nor an artifact
present here (and there is essentialyno real
differencebetweenthe films).

36
rflqwlrF?-44
,.lllrillr1iiiili
!r. :hese two films carefully. Both came
ltilmtmnrn ilifiEsame double packet, but they are not
.,r.ir-j\ identical. What artifact or error-
ililru|u,]Hr,
fi 6p1,r -;;n be seen that would account for
tlllilllilLll
Ir,;:e are no signs of an artifact or error,
llme:eis no real difference between the
.iitullllli||||lil,

llllllllilttlnnn
r
;r ,lrride stain
lr: - eXoperartifact
u ;i r:r artifact

ilmrumF
2-45
illllirlllllltni,r
:e:hnical error-if any-occurred here?
neshortening
,* lhere
-: was no error; this caserepresents
lillrrrurulyln--an'
rootless teeth.
lenture with plastic teeth was left in the
"
S mOUth.
llllllillllllriirrltllr:
u lnture with porcelain teeth was left in
llllllilrilr
Tin|:n'ent's
mouth.

37
Panoramic
Errors
andArtifacts
FIGURES
2-46 through2-51
In each of the following six panoramic films, a patient positioning error was made.
For each film:
1. Name the patient positioningerror.
2. Identify the specific findings on each film that identify the error.

2-46
FIGURE

FIGURE
2_47

38
FIGURE
2-48

FIGURE
2-49

39
 2_50
FIGURE

2-51
FIGURE

40
ffi[rRES 2-52 through2-57
ir each of the following six panoramic films, an operator-relatedprocedural error
n,'rsmade.For eachfilm:
il. Name the proceduralerror.
l" Describethe alteredimagecharacteristicsdue to the error.

FIEURE
2-52

FIGURE
2_53

41
 FIGURE
2_54

FICURE
2_55

42
FIGURE
2-56

FIGURE
2-57

(l
 FIGURES 2-SB through2_75
In each of the following l8 panoramicradiographs,
one or more errors of various
typeshavebeenmade.For eachfilm:
1. Name the error.
2. Describethe alteredimagecharacteristics
due to the error.
3. How is the error corrected?
As an aid, pleaserefer to the following tables
in the answersection.
1. Panoramicpatient positioning
2. Commonpanoramicoperatorerrors ".r"o.,
NorE: Beforeproceedingthroughthis series
of questions,you may wish to skip
ahead and answer the questions for Figure
2-i6. Artho'gh it is meant to be a
review,somemay find it usefulas a preliminarv
steo.

FIGURE
2-58
 FIEURE
2_60

el:l : ,,r.,.

FIGURE
2-61

45
 FIGURE
2_62

FIGURE
2_63

46
FIEURE
2-64

FIGURE
2-65

47
 FIGURE
2_66

FIEURE
2_67

48
 2_68
FIGURE

2_69
FIEURE

49
FIGURE
2_70

FICURE
2_71
tu
*::

n
FIGURE
2-72

FIGURE
2_73

5l
 FIGURE
2-74

FIGURE
2_75

52
FI6URE
2_76
This is a properly exposedpanoramicradiograph.
1 Can you list the five stepsin the taking of this radiograph?
2. Can you list the errors which occur with each step?
(A handytableis suppliedin the answersection.)

53
ldentification
ofMaterial
andForeign0biects

55
f

naterialscould have been used

nesial of the centralincisors?
rraterialscould have beenused IO
Jistalof the centralincisors?

,iiit
.;: i _2
'- u'hat metals might this patient's
'::fem&de?
- ,'.hat materialare the crowns of the
" - .:3threstored?
- :, :r€ the radiopaquelines seenin the
. - .:ri? of the anteriorteeth?

rrriffii"
rfl'; i_3

:: of crown has been placedon the

. : .:el incisor?

57
 Y

FIGURE 3_4
Whatrestorativematerialshavebeenusedtt
treatthe riehtcentralincisor?

FIGURE
3-5
What materialhas beenusedto restorethr
crownof thelateralincisor?

FIGURE
3_6
l What materialhasbeenusedto restorethe
crown of the right central incisor?
2. What might the two radiopaquedots rep
resent?
3. What other materialsare seenin this r-
diograph?
4. What is the causeof the radiolucentline:
at the upper cornersof this film?

58
cilntuns
3- 7
-r" patientwho
-::: involvesa 23-year-old
'm'r:r",:---itbr a routine examination. The full-
ril --1" -,dio-eraphic survey revealed a radi-
rE ,:'r_iect
flririirlu. on the cervical third of the root
lr -r ::' centralincisor.Therewas no resto-
riu..- - :. :his tooth, and it was vital. Therewas
u -. ---:-- of pain. With carefulquestioning,
'ur
u r-,. ::rl revealedthat shehadbeeninvolved
ilr r'i '*lomobile accident several months
:llllirii'. E -

; -,': is your most likely diagnosisof this

'uu,-:.:it1 ?
- ,n:rt are some other circumstancesor
nrr--: ih&t might produce a similar radio-
,r-;':- - :icture?

4m/m5
3-8
e -:: is the approximate age of this pa-
ul-' -{'-ir do you know?
- -re right central incisor in lingual or
* . =rsion? Give the reason for your
tiiui:
,iiilllll'r' : -

flE/tr 3-9
c -.;i iS the name of the appliance seen in
I --:-..qraph?
llllll
- -,-.esthis appear to be a young or elderly
'lrilriiris:.'Give the reason for your answer.
^ :,.t rvas the probable reason for initiat-
'|llliltr
-:,::1pe of therapy?

59
 FIGURE 3_IO
Namefive metallicobjectsthat can be iden-
tifiedin this radiograPh.

3_I I
FIGURE
1. What two forms of endodontictherapy
may be seenin this radiograPh?
2. Give two reasonswhy the lateralincisor
was not treatedin a mannersimilarto that used
to treat the canine.

FIGURE3_12
with whatmaterialare the central incisorsre
stored?

60
 FmURfS3-13 through3-37
\ iewing from left to right, tell what materials the arrows are pointing
to in each of
:he following radiographs.

FIGURE
3-13 FIOURE
3-14
l

FIGURE
3-15 FIGURE
3_16

*g
t

4* &
;i; s, 4
tr' ;' q

FIGURE
3-17 FIGURE
3-18

61
FIGURE
3_19 FIGURE
3-20

FIGURE
3_21 FIEURE
3_22

FIGURE
3-23 FIGURE
3_24
 3-25
FIOURE FIGURE
3_26

3-27
FIEURE 3_28
FIEURE

FIEURE
3-29 FIGURE
3_30
FIGURE
3_31 3_32
FIGURE

3_33
FIGURE FIGURE
3_34

FIEURE
3-35 FIGURE
3_36
 FIGURE
3_37

trilJfrE3-38
fo''-t materialswere used to restorethe man_
nrr':lar second deciduousmolar seen in this
l"iu:,ograph?

65
 FrcURE
3-39
What materialwas used in this fractured cen-
tral incisor?

FIGURE
3_40
An image crossingthe apex of these teeth is
slightly visible. This patient had difficult.v
breathing.What might the imagerepresent?

66
FICURE
3_41
1.Whatterm and what materialare seenin the right mandible?
2. What materialscan be seenabovethe edentulousridgein the left mandible?

FIGURE
3_42
What restorativematerialswere usedin the followine locations?
l. Left central incisor
2. Right central incisor
3. Left mandibularpontic
4. Rightmandibular pontic
5. Right maxillary molar root canal

67
 ttt
M :.1

.:." .

FIGURE
3-43
What restorativematerialsmay be seenin the following locations?
l. Maxillary incisor crowns
2. Mandibularpontics bilaterally
3. Maxillaryrightincisorroots
4. Maxillary left molar crown
5. Right mandiblein the bone beneaththe pontics
What is the natureof the horizontalwhite line seenin the patient'sleft mandibular
region?

FIGURE
3_/U
Name the restorativematerialsseenin the followine locations:
l. Maxillary central and lateral incisors
2. Maxillary right secondmolar
3. Maxillary left secondmolar
4. Mandibularleft first molar
5. Mandibularleft secondmolar

68
FWURE
3-45
\-rrne the restorativematerialsused in this patient. Specify the location in each
::se.

3_46
FISURE
1. What materialis seenat the angleof the mandiblebilaterally?
L What are the very straight white lines crossingthe left mandibular ramus?
material and
3. Why was the maxillary left lateral incisor restored?Name the
-trcationof the restoration.

69
 and
Developmenta
Defects
Acquired
oftheTeeth

11
 m+t
,, lqann€the developmental anomaly in the
mcisor.
lliliilrffiilrftil.
"' shat other condition of significance in
NomilMfurntic treatment planning is present in
umfi ilJ-rth.r

I
i
I
t

mm4-2
[L Describe the radiographic appearanceof
r(h nrmrrndibularfirst permanent molar seen in
tlm ruJ"iograph.
I what pathologic entities can be seen?

73
 4_3
FIGURE
complexionand is uncomfortablein
Johnny Ecto has sparseblond hair and a ruddy-red
and he has full pouting lips'
warm weather.The u',oge of his noseis deprlssed
1. What hereditarycondition doesJohnny have?
notedin two other disorders;name
2. The dentalfinding. ,n tr,ir conditionalst may be
them.

4-4
FIEURE
Mary Sweet, now 24 yearsold, was involved
as a patient in a dental researchproject when
shewas 18.Her nontreatablecariousmandibu-
lar first permanentmolar was extractedas part
of her overall dental treatment'
l. Based on the radiograph, what do you
supposethat treatmentprocedurewas?
i. Describe the radiographicappearanceof
the tooth occupyingthe place of the mandibu-
lar first molar.

74
 ?6URE4_5

-- . Je Boss is 22 years old and is the life of the party when he demonstrateshis
showedopen
-:--rlr to hold a glassbetweenhis two shoulders.The skull films
'.::anellesand wormianbones,the result of many open sutures.There wasfrontal
:,-.sing and most of the permanent teeth failed to erupt. There were also some
- -:ernumerary permanentteeth.
- \ame Clyde'scondition.
I . What is differentaboutthe roots of the permanentteethin individualsaffected
:. :hiscondition?

tmuE4-5
::::iti the abnormality in this radio-

." * r-3 one syndromewith which this find-

--
llilIlul :r associated.
b'"- -: is the importanceof recognizingthis
'rlru::i.
: in Children?
-

+7
{MnunE
i 'tr.- :::e conditions associated with the
{lir
second molar would you, as the
Innrrr]trur,uji--ar
r"rrr,, r --i radiologist, note in this radiograph?

75
 4-8
FIGURE
in this
1. What is the main problem depicted
radiograPh?
--i.
Wtt"t notation would you make 9n lhe
puti"rrt', chart regardingthe secondmolar?

4-9
FIGURE

4_IO
FIGURE

FIGURE4-I T
shapeof the
How wouldyou describethe root
molarsin this radiograPh?

76
 4-12
ll- What term is used to describe the varia-
in form of the first molar in this radio-
?
2- \['ith what syndromesmay this tooth form
amsociated?

4-13
tr- What is the most obvious abnormality
rm h this radiograph?
I- )iame two conditions with which this ab-
mality may be associated.

m 4-u
ffida Brokenbone is a 24 year old who is
'dmed to a wheelchair; she has had a long
frhfism1-of fractures of the long bones. She has
1frhe eyes-the sclerae of which are also
Mc-and is very small in stature.Clinically;
h teeth appear to have normal shape and
diim- She has a low caries history. When she
dss. as she often does, her anterior teeth
qmcar to have an opalescentsheen.
l- What is Belinda's systemiccondition?
t What developmental dental defect is in-
wnil\rcd?
3- What features of this condition are seen
Msgraphically?

77
 FIGURE4_15
What unusualentitYdo You see this radie
graph?

4-16
FIGURE
This case involves a l3-year-old female who
had Hodgkin's diseaseatage5. The only mani-
festations of the diseasewere low-grade fever
and cervical lymphadenopathythat persisted
even after 3 weeks of antibiotic treatment' She
receivedthe usual mode of therapy and is cur-
rently free of disease.
1. What is the common mode of therapy?
2. What effectsdid this have on her teeth?

FIGURE4-17
What developmentalanomalycan be clearl-l"
seenin this radiograPh?

78
 t -18
tril,"
Cr:mparethe radiographic appearanceof
gm$s of the mandibular second premolar
ffie first molar.
['. Holl-would you treat thesepulps? Give
r€asonsfor this treatment.

+ t9
*here is this radiopacity located?
U!,,.
B, Sthat does it represent?
s" *rhat alterations have occurred in associ-
vith this radiopacity?
Hon would you treat this?
-#*

4-20
ffi,,"
ldentify the following radiolucencies:
e- the crest ofthe ridge betweenthe sec-
ond premolar and the first molar
h- the one near the apex of the second
premolar
I Gir-e the term for the dentistry that was
done here and what it brought about. (Not
adverseconsequences especially.)
$" That other pathologic dental finding is
evident?

79
 4_21
FIGURE
1. Name the condition that af-
fects theseteeth.
2. What are the condition's
characteristic features? (Not
necessarilyall of them are in this
radiograph.)
3. How do these teeth looh
clinically?

4_22
FIGURE
1 What developmentalanomaly do you set
here?
2. What structure do the two thin radiolu
cent lines at the apex of the mesial root of the
mandibular first molar represent?

FIGURE 4_23
In reviewingthis radiograph,what points of
interestshouldyou note?

80
 and locate the entity representedby
radiopacity in this radiograph.

[il."n'hat developmental anomaly is seen

"I!..n-ilild you suspectthat this radiopacity is

more palatally or labially?
& ffiw elsecould you locatethis structure?

term is used to describe this particular

circumstances?

8l
 4_27
FIGURE
1. What term is usedto describethe clinica-
appearanceofthe coronalportion ofthe latera'
incisor?
2. What other anomalYcan be seen?
3. What treatmentwould you recommendl'

4_28
FIEURE
1. Toward what endodontically significan:
structuredoesthe radiopacityon the left of th;
radiographappearto be Pointing?
2. What are thesebilateralradiopaquestruc-
tures?

4_29
FIEURE
What would you interpret the bilateral rad'
opaquestructuresseenin the lower cornersri
this radiograPhto rePresent?
After checkingyour answers'take a break'
Welcome back. Ready to start again? He::
we go.

82
{ill{ii{i-ry.L30
"rri,l..'-i.Iures account for the notched ap-
,1111
r ii,"-.--: -.i the mandibular incisor teeth?

;tilxiil,m,f
L3l
,, -.- developmentalanomaly can be seen
*: titrgraph?
-.:: are the radiographic signs of this
"

,ffiffi-eE
r32
- . .;ri ingthisradiograph,what notations
ii . - ..".u make concerning the maxillary
- :
,,,,,,.t

^ :: 1\'peof restorationwas usedon this

83
 4_33
FIGURE

radiograph?

84
ffiuRE4-35
Julie Eatmore is a healthy 2l year old with a slight weight problem. When you
eramined her teeth clinically the lingual of the anterior maxillary teeth was shiny
and smooth and seemedto have very thin enamel. Sensitivity of the teeth to
temperature changesis in fact what brought Julie in for her visit. Although her
medical history was noncontributory, she did finally admit that she was receiving
psychologictreatmentfor an "eating disorder."
l. What eatingdisorderdo you supposeshe has?
2. What relationshipdoesthis disorderhave to the teeth?
3. What's wrong with the teeth?
4. What is the term used to describe the appearanceof the maxillary anterior
teeth?

tL36
term is used to describethe spacesbe-
theseteeth?

85
FIGURE
4-37
What term is used to describe
mation seenin this radiograph?

FICURE
4-38
This patient is 7 years old. What is your
pressionof the radiolucencyjust distal to
last molar?

FIGURE
4_39
The only tooth that this patienthas ever losti
the right mandibular permanent first
What term is used to describethe phe
that has occurred here?
(
 /r4
sase,the patient,now l1 years old, had
, of high fever when he was very
l
filr"ffimimatewithin one year the ageat which
probably occurred.
@-n''hat was the result of this fever?
$ nrhat other teeth, not shown here, could
heen affected?

+41
t is a lO-year-oldboy who just had a
cramination. Although he has no caries
permanentdentition,he hasa historyof
first deciduousmolar,which has
ted.
uiewing this radiograph,what would you

442
lrcatures depicted in this radiograph are
ic of what condition?

1L43
1-ourimpression of:
pontic material
lfl1,tfrre
@,ffienadiopacityassociatedwith the pontic
s'ilhe radiolucency at the apex of the second

87
 FIGURE 4_/U
Will the mandibularsecondpremolarerupt'.)

FIEURE 4-45
After viewing this radiograph,what do
report?Be thorough.

FIGURE4-46
What conditionis illustratedin both of
radiographs?

88
 li/im.frf,1_47
-' .' - ild y*oudescribethe shapeof the max-
ilm,- ,.:ral incisor?

,ril/ffi,Jps
"!-49
:: pulpalconditiondo thesetwo radio-
llruti -::nonstrate?
. ,'-:i is the significance
of this in caseA?
- is the significance of this in caseB?
':

89
 4-49
FIGURE
1. What term is usedto describethe relation-
ship of these maxillary molars to the mandibu-
lar ridge?
2. Name the two contributingcauses.

4-50 through4-55
FIGURES
The next group ofquestions relatesto cariesor to the sequelaeofcaries.
In each figure there are lettered arrows indicating a surface to be interpreted. For each arrow"
selectone of the following numbersthat you feel most accuratelydescribesthe caries.

V 0: no caries
l: incipient caries;halfway through the enamelor less
2'.early caries;limited to enamelonly
3: frank caries; involving the dentinoenameljunction, but lessthan
between the dentin and the PulP
4: deep caries;more than halfway through the dentin and/or encroac
upon the pulp

V
Interpret only the surfacesindicatedby the lettered arrows. Do not interpret the caries as dee
gret
than indicatedon the radiographeuenif you suspectthat clinically the cariesmay be of
depth.

90
 4_50 4_51
FIGURE
FIGURE

4_52
FIGURE 4_53
FIGURE

4_54 4-55
FIEURE
FIGURE
 FIGURE
4_56

FIEURES
4-56 through4-58
In each of the following casesa periapicalIe-
sion of pulpul origin is indicatedby a lettered
arrow. For each lettered arrow do the fol-
lowing:
l. Give the radiographicdiagnosisor differ-
ential diagnosis.
2. Statethe probablecauseof the lesion.

FIEURE
4-57

FIGURE
4_58

92
EE4_59
illrrsi.lt, is a 35-year-oldpatient who was treated
'mlh eobalt 60 for an oral malignancy.
ffiliftihat pathologicprocessis affecting these
M:
A ffihich tooth shows the most typical
lillhniiml
$" $h-v do these lesionsoccur?
'ffi"Ho:n'can this sequelabe prevented?

rffiG60
ilI,.Gir-e a differential diagnosis of the peri-
rffillFrm.nfi
radi.lucency seenin this radiographof a
ffi-,Wrerur-old black female.
3 S'hat objective test would be of great help
luum &tsrnrining the proper treatment of this
m,l

4-61
the radiolucenciesseenat the apices
fu mandibularfirst and secondmolars in
mmrfoqraph.

93
 FIGURE
4-62
1. What is the probable cause of the bifur_
cation involvement of the mandibularseconi
deciduousmolar?
2. Can this condition affect the developing
permanenttooth?
3. If so, what is this condition?

FIGURE
4-63
l. What anatomic structure produces the
semicircular radiopacity at the apical third d i
the root ofthe left central incisor? |
2. What anatomic structure producesthe ra_|
diopaqueline along the incisal third of theseI
anteriorteeth? |
3. Why may one or more of these teeth hc I
nonvital? |
4. a. What developmentalanomaly t* |
"un d
seenin associationwith the crowns I
the central incisor? |
b. What analogousconditionmay be seenI
on the occlusal of the mandibular pre_|
molar teeth of Asians?

FrcURE
4-il

94
m ffie event of caries, would tlie premolar
seenin this radiographbe moresuscepti-
@ an early pulpitis than normally? Give the
for your answer.

tw-o developmental anomalies that can

rffisnto be developing in this radiograph.

Ie to the size of the teeth seen in this

, what term is used to describethis
tal condition?

95
 FIGURE
4_68
1. What pathologic entities can be seenit
this radiograph?
2. What condition is compatible with the
pathologic findings in this radiograph?

FIGURE4-69
What change can be seen in the crowns
theseteeth?

FIGURE4_70
JanetThistleis a26yearold whoseteeth
cally appear normal except for some at
Her radiograph,shownhere,demonstrates
typical appearanceof her condition. Her
vious radiographic dental records
that her primary teeth were similarly in
When the family history was taken,
found that her 7-year-olddaughterhad
involvementof both her deciduousand
nent teeth. In addition, the deciduous
appearedto be grayish,opalescent.
l. What radiographicchangescan you
serve?
2. What's the condition?

96
i EdmF4-7t
;.-r 1'outhink this patient has a previous
:fi;ri--,. of trauma to his mandibular incisor
utlt*i:

- .i1at treatment is evident in this radio_

g"-r'-
' ,u
irat would you interpretthis radiograph
- - - - = r a n t9

w.ff 4-72
.qhat developmental defect can be seen
in
ln,:*,- with the right deciduous central
'iis11
,u,;. . -:ral inCisorS?
- ;r hat is the cause ofthe delayed eruption
Im:ire ight permanent central and lateral in_

97
 4-73
FIGURE
Mary Quitecontraryis a l0-year-old girl
fell off her bicycle 3 yearsago. Her teeth
sensitiveand achedfor a short time but eve
ally felt better. Recently, she has had
mild discomfort in the soft tissue high
the front teeth. Upon examination two
lides were noted in the area of the m
fold adjacent to the maxillary centrals.
What sequelaeof the fall can be noted
theseradiographs?Be thorough.

98
imilf;sr-74
llti"llll* .:'ns had her mandibularleft second
iln 1 i * i e\tractedseveralyearsago because
. -:.ache.During a recentdentalvisit, a
illlriil , 'nalgam was placedin the mandibular
- ::-r-rlar.
After her visit, shehad sensitiv-
:: and cold, and eventuallya constant
,li- ,-- developed.Upon reexaminationit
1l1l;,
lllu:l
-:-i that the first molar was tender to
- -:. and this radiographwas taken.
: is your diagnosis?
did this patienthavepain?
.rldis this patient?
.: developmentalanomalyis associ-
:he achingtooth?

qilmiftsj-75
-
LLLLIILII:: physiologic process that has
teeth to have this occlusalcon-

::relspms.tal anomaly do you see

l=ine it.

99
 FIGURE
4_77
What developmental anomaly do you see
here?Define it. (The tooth on the extremerigh,t
of the radiograph is the right central incisor.)

FIGIIRE
4_78 ]
1. What conditionis presenthere?
2. With what fibro-osseouslesion may thi$]
be associated? r
3. Name two other conditions in which you ]
may find this lesion.
l
I
l

FIaURE 4_79
In viewingthis radiograph,whatthreefindings
do you note? This Z}-year-oldpatient wasi
completelyasymptomatic at thetimeof exami-
nation. He has a previoushistory of chronic
sinusitis.

100
 illt-tr{ametwo good reasonswhy endodontic
,.was performed on this molar insteadof

I $"hat do the little radiopaquespecksat the

of the molar represent?

m^/r-81
k developing anomaly may be seenin this
disemph?

features depicted in this radiograph are

riFtffingnomonicof what condition? You should
h'n this becauseyou've seenit before.

101

http://dentalbooks-drbassam.blogspot.com/
 FIGURE
4-83
1. What developmentaldefect does this ra_
diographillustrate?(you've seenthis before.
too.)
2. Unless prevented,what is a frequent se_
quela?
3. How may this be prevented? ]
4. What tooth is most commonlyaffected? l
5. Can this defectoccur bilaterally?
i
I

F *' RE4 _aI

This shouldbe familiar ro you: I
l For what condition does this radiograph
I
presentpathognomonicevidence?
I
2. Is this condition hereditary? |
3. Are the cariesa usualfinding?
I
4. With what other conditionuri th" findinss I

102
iltum,F5.l-95

-:: common feature can be seen in

- :: radiographs?
'' -..:h of the three radiographsshowsa
;: condition?
' - ::r of the threeshowsa "healed" con-

' -.::i of the threeconditionshasthe best

103
FIGURE
4_87
What unusualfinding would you report upLr:
viewing this radiograph?

FIGURE
4-88
What is the radiopaquemasssurroundingthi.
mandibularcentral incisor?

FIEURE
4-89
What are the round radiopaquestructuresseer
closeto the pulp chambers?
 http://dentalbooks-drbassam.blogspot.com/

fimro4-90
lllillfrltttllnu
s h[r>. Pearl Jones. She had both of these
1lilirnruru'mrg radiographs taken at the same time-
,^nnrt: lo intervening treatment between the
,,,iriujl
',tttwunliiruinngraphs.Why has the "enamel pearl"
iwrir:,iil -\ disappeared at alTow B? Now
rttlltn
lwii{tttuu
nr :eCl1,' going to have to do some
'llllllltttrrrrrMmms

105
http://dentalbooks-drbassam.blogspot.com/

Lesions
Atfecting
thelaws

107
 -..n is 37yearsold. You're looking
:=rapical radiographof a mandib-
Jllt]l tl" - ... The patient said that the area
,[ll :3tic and that the mandibularleft
ll[lfilllt T .- - .,.as extracted approximately 5
'iltill0f, l,- :
' -,riograph suggestiveof a benign
l llruii,
J r --. 1 i e S i O n ?
r{llrliriL ::1emost likely diagnosis?
'': -: ..3re no previous history of ex-
.rould be the most likely diag-

' --J r ou obtain a definitivediag-

r:--: : :! 13 yearsold and plays floor

- : --rr Canadianschoolsport.She
rrililIr:-=..:.
ilrrL This radiolucency was dis-
--- ; a routine dental check-up.
l ^ - +^ l ^L^^l- --.^
- ^, , a: - ^

-:g. she statedshe was struck

. . hockeypuck and that herjaw
:!rr a few days.
r-storyand radiograph,what is
:iagnosis?
-: e clinicaltest would be heloful
: - '.t:ionaldiagnosis?
" -: \ou obtaina definitivediag-

r- -. ;entral lesionsof bone that

- ::iiar radiographicappearance
r .:r- - :.r Occurin thiSarea.

:.. a 52-year-oldfarmer, pre-

- : r .-!t with a complaintof a tin-
llirllill" - . :he left sideof his lower lip.
: -..rus from the mandibular
r Dosterior.This radiograph
' : mandibularleftmolararea.
: ;:tOrr appear benign Or ma-

,- iifferentialdiagnosis?
State
';"rch alternative.

r09
 FIGURE
5-4
This asymptomatic radiolucent lesion ; ru
found upon routine examination in a 55-1eur
old male. There was no history of trauma. aM
although the patient was taking diuretics jim
hypertension, he was otherwise healthl :r,n
temically.
1. What is this lesion?
2. Describe the radiographic features of im
type of lesion.

FIGURE
5-5
1. Name the two most likely explanations
the small radiopacity seenbetween the
the canine and first premolar teeth.
2. Which odontogenic cyst commonll-
velops in this area?
3. Name four other radiopaqueentities oo4
monly seenin this area.
^-l-- ^ ^ ^ - :- .L :^ ^-^^

FIEURE
5_6
1. What is your interpretation of the odd
genic pathologic condition seen on this rafi
graph? |
2. Would you sendthe surgical specimenfl
biopsy? Give the reasonsfor your answer-
]

ll0
nld you interpret the multiple radio-
seen in the central portion of this ra-
to represent?

old is this Patient?

pathologic entitY is Present?
I a lesion always iatrogenic (i.e ' , the
a dental procedure)?

periodontal cyst can be seen in this

tr-o theoriesconcerningthe etiology

sr"st.
possible for this cyst to have a high
rate postoperativelY?

lt l
 FIGURE
5_IO
l. Give your differential diagnosisof :c
conditionrepresentedby the radiopacitya: :=
inferior border of the mandible.
2. How would you proceedin order to ob_.-:
a more definitiveradiographicdiagnosis?

FIGURE
5_I I
1. Give a differential diagnosisof a thr;r-
enedperiodontalmembranespace.
2. Using this radiograph,substantiatei
choice in this particular case. The patien:
asymptomatic,and all teeth are vital.
3. Give a differential diagnosisof a
enedlamina dura.

FIGURE
5-12
1. In viewing this radiograph,what fin,t -U
would you report?
2. a. What is the location of this finding.
b. What prominent radiographic lam-
mark helps you with this location?
Which anatomic structure produced '-:c
wr,.,
l. Jelineated vertical line about 1 cm frc'u
th,. l:ft edgeofthe radiograph?

112
 Lt3
1,Lee is an 18-year-oldfemalewho has had this problem sinceage3. Clinically, her
rppears swollen bilaterally; she is asymptomatic. Radiographically,bilateral multilo-
cnpansilelesions are noted in both the mandible and maxilla.
ffi *hat is your diagnosis?
1 Cienthis condition be diagnosedfrom radiographsalone?

g--t4
on the trabecular pattern of the al-
betweenthe roots of the mandibu-
milar.

ilt5
fimilmem *'ith the three-unit bridge seen in
'numngraph is a 42-year-oldwhite female.
'llrlftrrtqe
lr as constructed shortly after the
: masextracted.The patienthasbeen
-ie bridge for seven years, yet the
:;atrternbeneath the pontic doer :rot
.r-fTl?I. .e
': the radiograph, what is your rrl*g-
3?
- nould you confirm this?

113
 FIGURE
5_16
Cecily Glomer is 23 yearsold and suffers:
kidney diseasethat hasled to renalfailure .
the past 2 yearsshehasreceiveddialysist:.
ment while awaiting a kidney transp---
About I year ago shehad the lower first n -
extracted.
1. Whenis the besttime to extracta too:,-
a patient on dialysis?
2. What specificlesion does the radiop;; -
arearepresent?
3. What are this lesion'scharacteristicra;
graphicfeatures?
4. Name two broad categoriesof syste:-
disordersin which this lesion may be seen
5. Would the mandibular secondprem. -
be an easytooth to extract?

FIGURES
5-17 through5-23
Each of the followingsevencasesinvolvesa periapicallesion.Someof the lesionsare radir -"
centand someareradiopaque.Somelesionsarein the maxillarysinus.The purposeof this ser:
is to help you to recognizethe variouspresentationsof inflammatoryperiapicallesionsof pu,:-
origin and distinguishthem from other, very similarappearinglesionsthat are totally unrelate;
the pulp.

FtcuRE
5-t7
The mandibular first premolar in this rac "
'
graph is nonvital.
1. What would be your interpretationoi -:.
periapical radiolucency seen in this rat "-
graph?
2. With what normal anatomic strucr- :
may this be confused?
&)
v 3. What notablefindingswould you ui::_ ,,
,1!1
,lii.::1.,,'; passon to the endodontist?

114
 *t8
,m]'nur interpretation of the radiopacity
r*ith the apex of the maxillary left
premolar?The tooth tested nonvital to
and electricpulp tests.

Lt9
differential diagnosisof the radiopacity
of the mandibular first molar in this
The tooth is vital.

L20
black female presented to the
ffir a recall examination. The routine
M radiograph revealed multiple radio-
about the apices of the mandibular
eeth. The teeth were asYmPtomatic,
:rai. and were not sensitive to per-
rilllllllliiillllllliiilllrT.,.
fu,itu,:
rs 1'ourdiagnosisand recommended
:'
lllllllllilllLlLLLlL,;:rrl::
riw,'r*:
conditionis this said to closely re-
,r,')iii|uuutll
u

ll5
 FIEURE
5-21
Give a differential diagnosisof the rad-:,1.
cency at the apex of the maxillary right :lrrtliiL
premolar.
By now you sfuouldknow this cold.

FIGURE
5_22
All of the maxillary teeth are vital to pulp
1. What radiopaquelesion may be seen
the maxillary sinus?
2. An identicallesionmay be seenin
condition-one associatedwith pulp
mation. What is this other condition?
3. Why is the distinction between the
conditions important?

FIGURE
5_23
l. Give a differential diagnosis of the
periapical lesion seenin this radiograph.
in mind the anatomic location of this lesion-
2. In the absenceofan adequatehistory
on the basis of this radiograph what, do 1
suppose,led to the developmentof this

il6
 ffitRE 5-24
What is your differential diagnosisof the lesion in the left maxilla?
What is the causeof the large radiolucent area affecting most of the maxilla?

F25
I-ovejoy is a 19-year-old college
who attendedhis older sister's wed-
meption two days before his problem
Thanks to a copious flow of pink cham-
Georgewas feeling no pain but vaguely
hitting himself in the face with the
door in responseto an urgent re-
frr more ice cubes. His chief complaint
uthnthis jaw "hurt" when he masticated
The third molar was vital.
in 1-ourdiagnosis?

F..26
lpwment had a toothache sometime aso but q'':
iln'uum-snri v asymptomatic.
f rxoemtif-v the radiolucent area at arrow A.
T' rmrerpretthe radiographic findings in as-
q'ith the following areas of the maxil-
\!ffnllrrunufirrm
lttnnrnn'
w;,ond premolar:
". :oronal portion
r :L\tt
" :eriapical region
Inrr,-i::-rnlYou shouldget this.

117
 5-27
FrcURE
presentedwith a large swelling
This caseinvolves a 2O-year-oldmale patientwho
the swelling had beenpresentfor several
on the right sideof tne iate. He statedtlat
All teeth were vital and there were no
y"u.r, uirt rre had never sought treatment.
skin lesionsor other bony defects'
1. Give a differentialdiagnosisof this lesion'
2. What do You think this lesion is?

118
 patients' radiographsare shown
md C. All three patients have the same
and are typical of most patients with

thesepatientsblack or white?
old are thesepatients?
rhey male or female?
theseteeth likely to be vital?
ffihar is the name of the condition?

++r
 5-29
FIGURE
1. What is your impressionof the rad,':'
city associatedwith the mesialroot of the :;,;
dibular first molar?
2. Is this the common location for -:trrr
lesion?
3. What is the treatment? Give the reai:mru
for your answer.

FIGURE
5_30
This radiograph was part of a routine
mouth survev of a 43-vear-oldblack femals-
small hole in the occlusal surfaceof the
prepared without the aid of anesthesia
vealedthat the mandibularfirst molar was
tal. The patient was asymptomatic.
What is your impression of the radiopacity
the apex of the first molar? (Clinically the
sion was well delineatedby a radiolucent
that extended to and included the apex of
distal root.)

FIGURE
5_31
With the help of this radiograph, explain
reason for the extraction of the ma
first molar.

120
 '&n'ellopmentaldefect may be visualized
!1,,m's
seehow good you are.

5-13
lrulfWft!&rr
developmentaldefect of the jaws do

I Wrl,ii other developmental defect is

fim@i\wM"
liii Wlrhiilstructure does the oval-shaped
ra_
ltttiiiuutttilruurii;,n,
-n the middle of the defect represent?

121
 FIGURE
5-34
The patient, a 46-year-oldmale, was all"nml
tomatic. Upon examination a palpabledeq'en'
sion was noted on the lingual aspect o{ @
mandible level with the floor of the moum

122
 panoramic pati.elt positioning error was made in taking
S ryr this film?
m m'hetcausedthe radioluc"n"y u".oi, the apicesof most .?.
of tile maxillary rceL'i . n
u'a^ttlarv teeth?
Mffitra differentialdiagnosisortn" t"ri* in the left mandible.
4[ ilrhefi is the most likely diagnosis?

ilr,'rr:;h
shouldbe your choicefor the most likely diagnosis?

123
 FIGURE
5-39
This radiograph was difficult to take t'e- .
the patient, a l9-year-oldmale, exhibite: '
mus and some sensitivitv in the molar trr:fr,i
Additional symptoms with which the p,,i
presentedincludedswellingof the right s,lr
the face, low-gradefever, and earache.
1 What is your diagnosis?
2. Will the third molar erupt any
Give the reasonsfor vour answer.

FIGURE
5_40
The patient in this case, a l9-year-old
female, had absolutely perfect dention
visual inspection. The soft tissue
normal, and the patient was asym
The routine radiographsshowedalmost i
cal lesions in all four quadrants. The oral
gienewas adequate.
1. Give a differentialdiagnosis.
2. What is the most likely diagnosis?

FIGURE
5-41
Johnny Every is 21 years old and is
slight discomfort in the posterior portion
mouth. Upon examination, you notice
gingiva on the crest of the ridge distal to
second molar appears swollen and sh
bluish in color. This radiograph was
the time of examination. No treatmenr
given.The patientwasasymptomaticwi
days.
What is your diagnosis?

124
3'surdiagnosisof the small radiopacity
rnith the crown of the erupting third

m used to describethe radiopaque

$e alveolarridgeunderthe pontic?

mndnu-graphsare from two different pa-

lhffi of whom are female, in their mid-
nrymptomatic,and healthy.
do both patientshave?

125
FIGURE
5-45
Name at least five separatefindings thu
should report from your observation of
radiograph.

FrcURE
5_46
Give a differential diagnosisof the small
lar radiopaque structure seen in
with the maxillarv sinus.

FIEURE
5-47
Approximately 80 per cent of the
sinus in this radiograph appears
opaque,whereasthe remainder appears
lucent. In viewing this radiograph, how
you interpret these findings?
 L48 through5-53
ffie next lesions have similarities and may be helpful to study them as a group.

nffiE 5-48
f,ere is a situation in which two patients have the
d*ges. The mature lesion pathognomonic. same lesion but at different
is The male patienJi, ury-pto-atic, as
fo the feniale patient. In fact, both patienti are in ,rr"ir'-iJ-,.'""iti"r,
und in both
Gflsasthe mandibular molars are vital_,are free of caries,
unJ t uu" never been
mmored.
l- Which is the mature lesion?
l' what radiographic similarities and differencesare there
- between the lesion at
tfre stageshown in A and that at the stageshown in B?
3- What is the diagnosis?
4. What treatment is required?

!L4g
was taken upon routine exam-
nn ld a l9-year-old female patient of
-{.mericanextraction. She has never
,ruuffimndontic
treatment. The mandibular
:r-enolar is vital. The patient has no
ro p'roblems,and there is no historv of
lmillllltlttflililmnru
i'\,tl -t p s .
frha.:lesiondo you think is present?
iltllfi]lilirilllri
i' _{:'\'e seenthis before!)
rr:,:ten[upon the lengthof the premolar

127
 FICURE
5-50
l. What is your diagnosisof this radi
lesion?
2. Are the radiographic findings su
warrant surgical excision?
3. Is the radiographic picture sufficiem
use in establishing the final diagnosis of
case?Give the reasonsfor vour answer.

FIOURE
5-51
The radiograph shows a lesion found in a 34-year-oldwhite male who was seen
mainly for a complaint of intermittent sensitivity to hot and cold in the mandibular
left molar region. The large restorationsin the areawere presentfor years. Exami-
nation revealed expansionof the buccal and lingual cortical plates in the region of
the left premolar area. All of the teeth were vital.
1. Give a differential diagnosisof the lesion in the left mandible.
2. What diagnosticpossibility is the best choice?

128
 5-52
rlmrient'a32-year-oldwhite male,presented
with mild paresthesiain the lower lip on
ilo*ted ..wisdom;;
d#;il;e intoseeif rhiswas
the
Bffi;":,11"-.",3::l-"j*,:I:
$rurse.Uponexamination therewasno evidence or
drle' and the overlying soft tissue appeared "rpunri#ililH;"rilJltrlff:
normal. Gir; ;;ii;renrial diagnosisof the
iun in the left mandible.

5-53
mnrient is a l9-year-old male with an
ic mild swelling in the right side of
- What do you think this lesion is?
This lesion is often associatedwith one
impactedor uneruptedteeth, occurs
rte tooth-forming years of life, and is
characteized by the presenceof

F54
ffiruuum
re-""ron
is presentin the maxillarysinus?

129
 FIGURE
5_55
1. What anatomic structure do the radi'r':u'
cent vertical lines represent?
2. What is the radiopaque material in :mur
cervical area ofthese teeth?
3. With what diseasemay the two prece@
entitiesbe associated?

FIEURE
5-56
This caseinvolves a patient with a history d
apicoectomy of the maxillary lateral inci
What condition does the radiolucencv il
radiographrepresent?

FIGURE5-57
A biopsy of this asymptomatic lesion on
crest of the mandibular edentulous ridge
vealed normal lamellar bone. What is your
agnosisand treatment?

130
lm5-58
S"year-old white female presented to the
rufir a routine examination.The periapical
of the mandibular left molar region
The teeth were asymptomatic and
rital, and the serum calcium level
to be 9 mg per 100ml.
M,.DEscribethe radiographic appearanceof

hix to obtaining lab results, what is your

ial diagnosis?
ffiell other lab values were normal. what
be your tentative diagnosis prior to

L59
is 24 years old and, like her sister,
mal problems. Specifically, Lisa has
is glomerulonephritis. Although her
is being dialyzed regularly, it has aver-
fu following values: 12.5 mg of Ca per
1.6 mg of inorganic phosphateper
15 King-Armstrong units of alkaline
per 100ml. Histologically,the le-
ffia,t was resorbing the molar roots con-
giant cells. Urinary excretion of Ca on a
ium diet was 203mg per liter. She had
calcification in some of her fingers,
as in other areas. What was her sys-
iM. :,ondition that produced the changes
r@ur"n :hresetwo radiographs?

t31
 FIGURE
5_60
This case involves a 57-year-oldmale pa-r:nm
with a history of pain in the weight-be,:qg
joints. The alkaline phosphataselevel is
Bodanskyunits. He has had severalco
maxillary denturesconstructed,each one
comingtoo tight after someyears' use.
1. With the aid of the radiograph,tell
condition this history suggests.
2. What radiographicfeaturesof this
tion can be seenhere?
3. Radiographicfindingsclosely
those presentedhere may be noted in
other condition?

FIGURE
5-61
Thb radiograph shows multiple radiopaquemassesthroughout the mandible in a 48-year-
old black female. The patient was asymptomaticand was not aware of her condition. Therr
was a history of multiple
{g.Jtlasand sequestrationof bone.
l. Give a differentialdiagnosis.
2. What is the patient's condition?
3. What treatment would you prescribe?

132
 F.62
6ntient, a 26-year-old white female, pre_
d *ith pain in the left mandible and a
y of recent weight loss. The pain had
after routine extraction of the man-
left third molar and had been unsuc_
' treated for a 6-week period with vari-
hcal dressings in the extraction socket.
gmient'shusbandstatedthat shehad lost
and that he frankly suspectedthat
have cancer.
eramination, several tender lymph
u,ere palpable in the left submaxillary
The extraction socket appearedto con_
clot or granulationtissue.The mandib_
K first and second premolars were ex-
mobile and tested nonvital with the
pulp test. A fistulous tract could be
from the lingual of the first molar to an
eenthe apicesofthe first and second
. Radiographically, the trabecular
had markedly changedfrom the normal
seenI year earlier (Fig. A).
lfirpsies of the mandibular first and sec_
fars revealednormal viable pulps. A
in diet and antibiotics were pre-
The patient gradually improved, and
treatment was discontinued after 6
Endodontic therapy was completed on
lar first and secondpremolars.
s !-our diagnosis?

133
 FIGURE
5-63
This caseinvolves a9 year old who first presentedwith swelling in the right
side of the face and a low-grade fever. A deeply carious mandibular right
first molar was discovered and extracted. One week later the child re-
turned becausehis face was still swollen and a low-grade fever of 100'F
was still present. Intraorally there was a bone-hard swelling buccal to the
extraction site, the overlying tissue was slightly red, and the depth of the
mucobuccal fold was markedly diminished in the area. This radiograph
was taken at the secondvisit. The bone appeareddifferent in the right body
of the mandible. Additionally, a distinct periosteal reaction could be seen
at the inferior border of the right mandible, and severallayers of subperios-
teal new bone were visible.
1. Give a differential diagnosis?
2. What is your diagnosis?
3. How would you treat this?

FIGURE 5-64
This lesionwasfound on routineex
of an asymptomatic 35-year-oldmale. The
opsy proved the lesion to be an od
keratocyst(OKC).
1. What subtypeof OKC is this?
2. Can you name the other subtypes?
3. What are the radiographic features of
OKC?
4. With what syndrome is the OKC
times associated?Describe the salient
of this svndrome.
5. What is so important about distingui
OKC's from other odontogenic,fissural.
developmentalcysts?

134
 5-65
tfre angle of the mandible two separate
entitiesmay be seen.One is a nor-
ic structure; the other representsa
finding.
the normal structure.
a differential diagnosisof the abnor-

5S6
is a 65-year-oldedentulousmale
m particular complaint except that he
Itnhave new denturesmade. The four
mionsseenin radiographA were deter-
tn be in the buccal mucosaby taking
B.
Mm, 11'35radiograph B taken? Include
nt and relativeexposurevaluesas
[0 what may have beenusedin A.
lfl ffine a differential diasnosis for the four

135
FIGURE
5-67
The patient wasa27-year-old woman who
no stranger to dental treatment. When the
diopacity between the two premolars
noted, the area was checked clinicallv for
presenceof an amalgamtattoo on the al
mucosa.No such lesion was seen.Where
you suppose the amalgam tattoo was
located?

FIGURE
5_68
Give a differential diagnosisof the
material seenin this radiograph.
 ffi,5-69
lMHscase involves a 70-year-old female patient who came in for new prostheses. The
gmientwasnot in pain, had no known systemicdisorders,andhad neverbrokenany bones.
Il- fihat are the bilateral radiopacities at arrows A?
A &hat patient positioning error causedthese to be superimposedupon the mandible?
3- trhat is the causeof the radiolucentshadowcrossingboth sidesof the maxilla?
4- Iiow look carefully at all of the bone. Disregard the radiolucent panoramic artifact in
fu mterior midline of the mandible. Do you seethat there is very little cortical bone and
fu tb'eremainder of the bone does not appearvery radiopaque?What bone disorder does
l& elderly female patient have?
5- How is this disorder treated?

}.70
mtiograph shows a lesion found in a 22-
female patient who had presented
muutineexamination. Shehad no pain and
'ucmddremember no recent trauma. She
m constitutional symptoms. Aspiration
a slightbit of blood. Findingson biopsy
ed follow-up examinations for evalu-
rr the patient's serum calcium levels.
llMmre'',:lswere found to be normal, and aver-
rurymuc-. -<mg/dl over three readingson three
,urrufnruurui:e
days.
I,red upon the radiograph, give a differ-
;ragnosis.
rililrlr;,rii,r.
....::.'ed upon the history, what is the diag-
,i

137
 FIGURE
5-71
The patient in this caseis a 35-year-old:: *,r,
who haspoor oral hygiene,drinks heavill . iirrt
smokesa lot. He camein to have a looseI"*:,)t
extracted. This radiograph was taken ar:il ri.i
"floating tooth" was discovered.What li muL
differential diagnosisin this situation?

FIGURE
5-72
A 12-year-old male presented to the
complaining of sensitivity to hot, cold.
sweetsin the mandibular left posterior regi
After a sedativedressinghad been in plae
3 months, all teeth testedvital.
Based on these findings,what is your
mended diagnosisand treatment?

FIGURE
5-73
This is a periapical radiograph taken as part
a routine full-mouth radiographic survel'd
46-year-old black edentulous female. Shc
currently asymptomatic.
l Which anatomic area is shown on
radiograph?
2. Give a differential diagnosisof the
seen.
3. Which alternative is vour most
choice?

r38
 y74
edentulousmale presentedto
for a routine examination prior to
new complete maxillary denture con-

ntat region is this radiograph?

lmich tooth is this?
ffit would be your most likely diagnosis
cmdition representedby the radiolu-
the crown of the uneruptedtooth?
mdch odontogenic tumor, often associ-
an impactedtooth, frequently occurs
,,
is the large radiolucency superior to
portion of this tooth?

of odontomasare indicated bv the

featuresvisualizedin theseradio-
 FICURE
5_76
Johnnie Impact has several unerupted third molars in the mandible. There is a
history of intermittent periods of pain, a salty taste, and an unpleasantodor to his
breath. The latter problemspromptedJohnnieto come ,"" u..
1. Describe the radiographicfindings with respectto the mandibularthird molar.
2. Classify this impaction (mandibular third molar).
3. Name the condition that affects the mandiblejust distal to the coronal portion
of the third molar.

FIGURE
5_77
Paul Hardrock is a 45-year-old male who has a diseasethat is in fact
diagnosed
radiologically. All of his bones are similarly affected. He has been
told to avoid
tooth extractionsbecausethere could be severeconsequences. His alkalinephos-
phatase is moderately elevated but not excessively
iigh, and his erythrbcyte
sedimentationrate (ESR) is slightly elevated.rre is biing-properly managed
and is
not taking any medication for his condition.
1.-Givea differential diagnosisof conditions that may give this bony appearance.
2. What condition do you believeis present?
3. Why has he been told to avoid extractions?
!. what is the significanceof the elevated alkaline phosphataseand ESR?
5' What radiographically similar condition has very high levels of alkaline phos-
-
phatase when not treated?

140
 ffi,tRE 5-78
ilfir. Ronald Pennywise is a 65-year-old retired bank manager. He smokes two
reks of cigarettesa day and consumesalcoholdaily. His oral hygienewas so poor
lLat his teeth were literally destroyedby caries and in most areasbecamecovered
h5 gngva with severalsmall fistulas.His dentureswere subsequentlymadeby a
,ilenturologistto whom he paid $20 per month for I year. The denturologist, not
heing licensed to take radiographs, was not aware of the root tips and failed to
*tain a certificateof health,which is requiredby a properly licenseddentist.The
oft.iectivewas to save the patient "unnecessary" expense.Mr. Pennywiseulti-
merelyendedup in the dentist's office, sincethe l-year-old dentureno longer fit
nndthe denturologistdid not recognizea "lump" on the left mandibularedentulous
ritge.
Bffsedon the history and radiograph, what condition do you think is present?

5-79
gmmi,ent had a bridge made severalyears
her mandibularfirst molar was ex-
The patient is 45 years old and other-
hrat'.h1.
lffill$fu"rE:condition is present at the crest of
:eneath the bridge pontic?
Tl W'r: condition is suggestedby the pat-
'llllmmll|rrrrrt
::e alveolarbone in the mandibular first
,tltfinLl
]]|titlri
rr;; l
tu,'r;:is the radiopacityin the mandibular
llllll. n,, - -r area?

t4l
 FIEURE
5_80
This patient is a 35-year-oldmale with two impacted mandibular third molars.
1. Compare and contrast the pericoronal radiolucenciesin the two mandibular
third molars.
2. Classifythe impactions.

FIaURE5-81
This patient is a 25-year-oldfemale who, becauseshe had lost her mandibular
first
molar, never realized that her mandibular secondpremolar had not erupted.
l. Give a differentialdiagnosisof this lesion.
2. Which of your choicesdo you think this was?

142
n$f,E 5-82
SSm-.you've seenthis before! The patient is an asymptomatic38-year-oldmale.
f)iagnosethe radiolucent lesion near the inferior margin of the mandible.

ffiaRE 5-83
lhn older male patient has neglectedhis teeth for a number of years, although at
rne time he had a fair amount of treatment. The patient hastwo mandibularmolars,
:ne in the "L" side and one in the "R" side as labeledin the figure. Associated
i':th both of these molars is a radiopaque area within the alveolar bone near the
a:lces.
-..naDare and contrastthesetwo lesions.

143
 I

FIEURE
5-U
This 35-year-oldfemale has a lesion on the right ramus. She routinely visits her
dentist yearly and was asymptomatic. She had this radiograph taken becauseshe
moved to another city and her new dentist had a panoramicmachine. Her previous
dentist had taken routine bitewing films and the odd periapical film and failed to
detect this lesion.
1. Give a differentialdiagnosis.
2. Commenton the history.

FIGURE
5_85
This older patient had this radiograph taken prior to having dentures made. A
number of radiopacitieswere seenin the right ramus area. What might these be?

14
Local
ization
Techniqu

145
 OFOBJECTS
ORSTRUCTURES
0bjectRule
lfu sometimes necessarv to determine
foreign objects or dental structures
or lingually situated. A relatively
for doing this is calledthe buccal DIAGRAM{A
rule or shift. It is necessaryto take two
radiographs of the area in question.
radiograph is taken using the proper
technique.The secondradiographis
by changing the position of the x-ray
The flow of the x-rav beam is directed
either the anterioror the posterior.If
. . - _ 'f l
or structure is located buccally, it
to have shifted in the direction that
phic beamis flowing. If the object
is located lingually or palatally, it DIAGRAM.IE
to have moved toward the source
on. Refer to the diagrams.
lA is an occlusalview in the mandib-
gmmolar-molar area. The dark object is
ornthe buccal surface,and we can seeit

view in DiagramlB is the same

in 1A. In order to demonstratethe
*merely
of the fot'€ ct, take a
priapical like the onein Diagram lC. DIAGRAM{C
liation flows from the posterior to'the
Note that the object has moved to-
anterior. This indicates that it is lo-
v.
urke a look at Diagram 24. The dark
ob.iectsare located at the apices of the
. When the second radiograph is
shown in Diagram 28, the most ante-
llfri*Et moves more toward the anterior.
realize that the direction of radiation
mrfrom the posterior to the anterior. The
DIAGRAM
2A
ohject is thus a buccal object, and the
rrrrrtullllllttruur
rqlrectis most likely attachedto the apex
,rrilnljl
furr second premolar. Well, that's all the
Itl'tliiilittflmm&,:l,trn need.
-VOU
"fmi-x understandthis principle, try the
,t\lltruuuu,
1'ou
ill 111'!'iiiT-.
eXefCiSeS:

DIAGRAM28

147
 6_I
FIGURE
1. What is the radiopaque structure located at the tip of the arrow in A called?
Z.InB it appearsto have shifted its position distally. Is it locatedpalatally or
buccally?

AB
6_2
FIGURE
Where is the impacted third molar located in relation to the secondmolar? A was
taken in the usual, prescribed manner, whereasB was taken with the x-ray cone
directed toward the anterior of the arch.
What's your answer?Rememberthe rule.

148
 AB
FTSURE
6-3
lf you look closelyat A, youwon't seeanythingunusualin the root structureof the
first molar. InB the horizontal angulationof the x-ray cone was changedso that the
beamflow was toward the anterior of the arch. what do you seein this radiograph?
Is it located buccally or lingually?

flGURE6-4
The buccal object rule works not only on the horizontal plane but also on the
"'erticalplane.Here's a good example.The arrow in A is pointingto a small silver
Jlol'. This radiograph was taken using a negative vertical angulation, whereasB
,{as taken using a positive vertical angulation. Note how the small silver alloy
:eparatedfrom the occlusal silver alloy in the latter radiograph. Is this small silver
"iloy located buccally or lingually?

149
 AB
6-5
FIGURE
plane' A was
This is another example of the buccal object rule used in the vertical
at a much higher
taken at a positive u"rti"ut angulation, whereas B was taken
silver alloy is
positive vertical angulation. Thi anow in B indicates that the small
sourceof radiation
moving or shifting up instead of down. It is moving toward the
silver alloy located
and not in the same direction as the beam flow. Is this small
buccally or linguallY?

6-6
FtcuRE
of
In A, there is a radiopaqueimage located over the mesial proximal root surface
x-ray cone' The
the secondpremolar.B was taken with a horizontalchangeof the
It is
x-ray beamwas directedanteriorly.Note the changeof the radiopaqueimage'
premolar. Is it located
now slightly distal to the mesialroot surfaceof the second
lingually or buccally?

150
 c localization
localizationmay be doneonly in somesituations,usuallyin the anteriorregion.There
methods, one using
s, one the "SLoB"
usrng rne JLU5 rule wrtn
rule with tne
the spllt
split lmage
imageand
and the
the other usi ,,object
other using
Lu..vr, in 4uJ
ur any uu45s.
image. we
vv e will first uuvsl
wlll lrrbL cover iluw
how the sLoB
tllc Jj-(Jt' rule worKs.
rule works. Suppose you have
Suppose you have aa
with an impactedcanine,and becauseof the chair shift you seetwo imagesof it, as in
6-7. The acronynmSLOB meansSameon Lingual, Oppositeon Buccal. The beauty of
ly simpletechniqueis that you neednot worry how the film was exposedo. *hi"h
machine moved. You simply look at the two imagesof the object in the radiograph. In
6-7 look at the tip of the crown on the patient's left side: it is superimposedon the left
incisor. Now shift your gazetoward the patient's right side. The question you must now
is: did the tooth mouein the samedirection as my gazeor in the opposite direction? If the
vesin the samedirectionas one's gaze,thetooth will be seenmore toward the patient's
it will be on the lingual. If the tooth moves in the oppositedirection of one's gaie, it will
toward the patient's left and therefore be located on the buccal. Remembei. Same on
Oppositeon Buccal. Now you're ready to try Figure 6-7.

trdw6-7
fl1etook a skull and taped an extracted tooth to it, and then took this panoramicfilm. The
quie:tion:did we tape the tooth onto the palate or onto the buccal plate?

151
 Now this is a real case.It was discoveredthat the patient,a youngman, had beenshot u it: I
a B-B gun sometimeduringhis childhood.Wherewould you look for the B-B? In the lip. .': I
somewherebehind the teeth?(By the way, the teeth were soundand vital.)

Another method of localization with panoramicfilms involves the use of the panoramic 1
of "object magnification." As we sawin the patientpositioningerrors,the teethbecome
if rhepatientis toofarforwardin themachine ,." ;#ffi
andtoofatif thepatientis positionea |

In studyingthis panoramicfilm, you note an impactedright canine.If this tooth were N

to be extracted or surgically ligated for orthodontic traction it would be important to I
know whetherthis tooth is locatedmoretoward the palateor more toward the buccal. I
What is the tooth's location?
I
152
|
 Review
0uestion
forNational
andState
Board
Examinati

r53
 PART
I

withFigures
0uestions

15s
 7-l
the most appropriate term for the anom-
m vhich the arrow is pointing.
#, fliastema
M. Concrescence
{[. f,lilaceration
lM.Dens invaginatus

7-2
patient is a 60-year-old male with
shortened crowns. He does not
a pipe; nor doeshe work in an environ-
*-here particulate matter or acid-
ingfumescanpollute the air. He hasno
eating disorders and is svstemicallv

processhave the crowns acquiredthis

?
#" -{nrition
B" Abrasion
(. Erosion
M" Amelogenesisimperfecta

7-3
mfratdevelopmental anomaly is the arrow

-'
ff- Phlebolith
ffi, Cementoma
0- Dentinoma
D" Enameloma

157
 7-4
FIEURE
The arrows are pointing to a radiopaqueareeru
the apices of the mandibular molars. Both ffi
the erupted molars are vital' and no hard bnr4lt
mass or expansion could be found on the bw'
cal or lingual cortical Plates'
Selectthe most appropriate causeof this
pacity.
A. Osteoclerosis
B. Osteoma
C. Benign cementoblastoma
D. Tongue shadow

7-5
FIGURE
Yellower than normal clinically, the
shown here have had this radiographic
anceever sincethey erupted; the primary
of the patient, a Zl'yeat-old male, lookedj
like this as well. The patient does not
from bulimia or anorexia nervosa, nor has
ever had much of a problem with caries'
What condition affects these teeth?
A. Erosion
B. AmelogenesisimPerfecta
C. DentinogenesisimPerfecta
D. Attrition

7-6
FIGURE
All of the teeth seenin this radiographare
1. What important condition should be
out in associationwiththe congenitallymissl
mandibular central incisor?
A. Cleidocranial dYsPlasia
B. EctodermaldYsPlasia
C. Rieger's syndrome
D. Incontinentia Pigmenti
2. The multiple periapical radiolucenci€il
this radiograph are due to:
A. Periapical abscess,granuloma,or
B. Dental papilla
C. Periapical cemental dYsPlasia
D. Chronic osteomYelitis

r58
mmE 7-7
lh nns radiograph, multiple pulp stones are
liltmrffi{ent.
Although they are usually of no signif-
iimnrrnre"
they are important in:
n- The diagnosisof dentin dysplasia,type I
S l[he diagnosisof dentindysplasia,type II
I Endodontic treatment planning
t All of the above

mmF 7-8
th ttus radiographall of the teeth are vital. The
1lmumrnt is asymptomatic, and no abnormality
ulCIoilrrtut
he detectedclinically.
ll mhat term best describes the space at
ruMnmu'*^\'.r
-1. Diastema
ts. Dilaceration
C. Primatespace
D. None of the above
* Wtlat
is the cause of the radiolucency at
inuumnu'n
B?
\. Lateralfossa
ts"Lateral periodontalcyst
[" Globulomaxillarycyst
D. Adenomatoidodontoeenictumor

159
 I

7-9
FIEURE
:
The lesion in the right body of the man:
pathologistreporte.c ' -"-
was removedand the
t:I'l.lilil,l:::r!]fr
it was a lateral periodontalcyst' From thc
{g'g;

t:::15:
below select the most appropriatestate:'-
concerningthis lesion.
''r'
A. As tlie pathologistreported,it is a la:.
-
periodontal cyst, and no more informatti
needed.
B. It is a lateral periodontalcyst, but I :-=-'"
to know if it is an odontogenickerattr-:
subtype.
C. it ls a lateralperiodontalcyst, and it '-:
be an odontogenickeratocYst'
D. The lesion is a lateral periodontal:
and it would be interestingto know if the '
-
is an odontogenic keratocyst subtl:'-
no significantdifferenc' :"
although there's
tween the two.

7_IO
FIOURE
panoramicfiim'
Pleaseanswerthe following questionsrelatingto this
in the taking of this film?
1. What patient positioningelror occurred
A. Patient too far forward
B. Patienttoo far back
C. Chin tiPPedtoo low
D. Chin tiPPedtoo high
2. Identifythe entitYat arrowsA'
A. Torus Palatinus
B. PeriaPicalcementaldYsPlasia
C. ComPlexodontoma
D. Soft tissueoutline of the nose
3. What is the thick radiopaqueband at arrows B?
A. Chin rest, due to improper patient positioning
B. Ghost imageof the hYoidbone
C. Orthodontic head gear
D.osteoclerosisorbonescaratahealedorthognathicsurgicalmargin
 7-t I
at this radiograph,you will note that
has socket sclerosisin the mandibu-
area. The following question has two
choices-try to pick them both. Which
following conditions may be associated
socket sclerosis?
Renal disease
Intestinal malabsorption disorders
Liver disease
Endocrine problems

FMURE7-12
I-ook closely at these two radiographsof two different patients. In both casesthe
teeth are vital, and both patients are asymptomatic. The following is a list of four
entities:
A. Incisive canal or incisive foramen
B. Incisive canal cyst (nasolacrimalduct cyst)
C. Lateral periodontal cyst
D. Primordial cyst of a mesiodens
For radiographsA and B, selectone statementfrom the abovethat is most consis-
tent with the radiograph.Only one statementis to be selectedfor eachcase,but the
samestatementmay be selectedboth times.

r61
 7_13
FIGURE
There are two questionspertaining to this radiograph.
1. What term best describesthe position of the premolarat arrow A?
A. Transposition C' Distal drift
B. Translocation D. Migration
2. What is the cause of the radiolucent shadow obliterating all of the apices of the
maxillary teeth?
A. A large radiolucent lesion such as an odontogenickeratocyst
B. Ghostsof the sinusair sPaces
C. Developer artifacts
D. Palatoglossalair spacedue to tongue malpositioning

7_14
FIGURE
This periapical film was taken as part of a
tine full-mouth survey in an adult patient-
of the posterior teeth in this quadrantwere
of caries and had never been restored.
patienthad no other bony lesionsand the
was negativefor BenceJonesprotein.
1. What is the most likely causeof the
lucency at the apex of the first molar?
A. Multiple or solitary myeloma
B. Eosinophilic granuloma
C. Sinusrecess
D. Lacrimal duct
2. What exposure error was made
this film?
A. Excessivepositive vertical
B. Excessivenegativevertical
C. Improper horizontal angulation
D. Placementof the film too high onto
palate

r62
 fieuRE
7-15
This patientis 22 yearsold and haslost most of his upperteeth owing premature
to
looseningand exfoliation.The patienthasno caries,yet he hasdevel,oped
multiple
periapical radiolucencies.clinically the teeth look normal; however,
the primary
teeth had an opalescentappearanceto them.
trIhat is the patient's condition?
A. Amelogenesisimperfecta
B. Dentin dysplasia,type I
C. Dentin dysplasia,type II
D. Periapicalcementaldysplasia,stageI
E' Dentinogenesisimperfecta(hereditaryopalescentdentin)

7-t6
ffi is your impression of the radiopacity
in the midline region?
du 0steosclerosis
M" Condensingosteitis
0- Cementoma
, trD.Complexodontoma

163
 i

.?*
w
AE

7_17
FIGURE
John Smith is a 45-year-oldwhite male who is the palatal side, or midwaY between
currently asymptomatic. All four first pre- two.
molars are missing, and all remaining teeth are A. Labial
vital. B. In the middle
1. What do you think the radiolucencyat C. Palatal
arrow A is? D. Impossibleto localize
A. Incisive foramen 3. Why do you supposethe roots of the
B. Superiorforamenof the incisivecanal eral incisors are blunted and shortened?
C. Incisive canal cyst (nasolacrimalduct A. Previous orthodontictreatment
cYst) B. Shovel-shaped incisor syndrome
D. Cementoma,stage1 (osteolyticstage) C. Idiopathic root resorPtion
2. Look at the radiolucency at arrow A D. A previous lesion and its removai
and, if possible,localize it to the labial side, fectedthe teeth

7_18
FIEURE
Here you can see a radiolucent lesion al
inferior border of the left side of the
The patient, who is currentlY as
a 56-year-old male. There was no historl
trauma, and all the teeth are vital. What is
radiolucent lesion?
A. Primordial cyst
B. Metastaticdisease
C. Salivary glanddepression
D. Fibrous healing defect

164
M*RS 7-19
''n''r.:,se involvesa right-handedmalepatient
-,::le age.Upon interpretingthis bitewing
'll
n b -..'runote the distinct line extending
:: :he cervical portion of the roots. The
l,,,,lr
urililr:--iras no complaintsof oral discomfort,
u ',:. thereany historyof radiationtherapy.
t[ * -; the causeof this line at arrows A?
- --:emicalerosion
i I -..'rlhbrushabrasion
. --cr ical caries
- i..rizontal root fractures

w*Fs 7-20
^ ",. :adiograph,the patient'smidlineis be-
' ihe teeth labeledA and B. There is a
-- Jomplementof teeth,and mild crowd-
1 *.
lrr! . ::esent.Now look at tooth C. What term
lrfr,::scribesthe appearance of tooth c?
- --rrI'lCt€SCeIlC€
i -::mination(schizodontism)
: -rsion(synodontism)
- \1:crodontia

165
 FIGURE
7-21
Look at this panoramic film. The problem is one of localization. As the consulting
radiologist you are requested to determine whether the surgical approach for a
ligation procedure on the maxillary left canine should be on the palatal or labial
side.
Is the impacted left canine toward the palatal side, toward the labial side, in the
middle, or impossibleto localize?
A. Labial
B. Midway between the palatal and labial
C. Palatal
D. Impossibleto localize

166
w,RE 7-22
*lr
:atient is a 28-year-oldfemale. Shewas asymptomaticat the time of her examination;
illlilr',o-"!er.
the panoramicradiographshoweda large lesion that was seento be crossingthe
ilri:l*:le. Therewas no history of trauma.Biopsy of the lesionwas carriedout, and the bigpsy
''l::--:i promptedan order for serumcalciumstudies.Serumcalciumvalues
were found to be
r' '-:-.1.The lesionwas excised,and the patienthasnot had a recumencein the past 5 years.
From the list below, selectthree errors that occun'edin the takins of this film.
{. Chin too high
3. Chin too low
--. Palatoglossal
airspace
l. Partial dentureleft in the mouth
E. Cotton roll or bite guide not used
I Frt-rmthe history, what was the diagnosis?
n. Centralgiant cell granuloma
B. Hyperparathyroidism
[. Traumaticcyst
). Odontogenickeratocyst

167
 FIGURE
7-23
Endodontic work, which was completed some 6 years ago, is evident in these
radiographs. The patient is currently asymptomatic. The tooth is not sensitive to
percussion.
You will note that this figure has severallabeledarrows pointing at specificentities.
Match eachlabel's letter (A, B, C, etc.) with the term that best describeswhat the
letter's arrow (or group of arrows)is pointing at.
A Lateral wall of nasal fossa 's"*,
B Superiorforamenof incisivecanal i
C Fibrous healing defect =-**
D Gutta-perchai*F-:
'E Nasolabialfold'S'=**
F Inferior meatus ,.{l
G Soft tissueoutlinEof nose
H Inferior turbinate
Periapicalabscess
Radiopaqueanterior restorative material ."::..*:,r-

FIEURE
7-24
For this radiograph, match each of the
in the left-handcolumnbelowwith the term
the right-hand column that best describes
the letter's arrow is pointing at.
A Enamel
B Scleroticdentin.
C Amalgam
D Reparative dentin
E Cast restoration
Dentin
Cervical burnout .
Caries

168
NEURE7-25
The patient,a Mexican-Americanfemale,is about 15years
old and her occlusionis
normal' Therewas no history of crowdingof the permanent
teeih and shehasnever
had any skeletal growth abnormality.
what is your diagnosisin this case?Remember-choo
sethe mostcorrectanswer.
A. Orthodonticroot resorption
B. Panoramicpositioningerror
C. Generalizedmicrodontia
D. Shovel-shaped incisor syndrome

t69
FIGURE
7-26
In this case,in which the patientwas a l9-year- A. Fibrous dysplasia
old female, there were the following radio- B. Hyperparathyroidism
graphic findiigs: C. Paget'sdisease
Generalizedloss of the lamina dura D. Dominant craniometaphyseal
Ground glass pattern of alveolar bone plasia
Severeerosion E. All of the above
The patient's serum calcium valuestendedto 2. Basedupon the history, which of the
run in the high normal range, but she spilled cific diagnosesbelow would you select'.'
calcium in her urine when she was placed on a A. Fibrous dysplasia l
low calcium diet. B. Primary hyperparathyroidism
1. Which of the following diagnosticpossi- C. Secondaryhyperparathyroidism,
bilities would be suggestedby the radiographic osteodystrophy)
findinssalone? D. Osteoporosis

=* FIGURE7_27
This is a radiograph of a resectedspec
taken from a 37-year-old white male.
upon the radiograph, the following diffe
diagnosiswas established:
Ameloblastoma
Odontogenicmyxoma
Central giant cell granuloma
Central vascularlesion
Considering the history and treatmenl
dered, what do you think the diagnosis rl'asJl"
A. Ameloblastoma
B. Odontogenicmyxoma
C. Central giant cell granuloma
D. Aneurysmalbone cyst
E. Centralvascularlesion

170
 7-28
the radiopacity at the angleof the mandi-
The patient was asymptomatic, had no
nic disorders or syndromes, and had no
skin lesions.From the list below, select
t-ro lesions that are the most probable
of the radiopacity:
,ffi Osteoma
tl, Si,alolith
0L Phlebolith
M" Calcified lymph node
K C1'sticercosis

mME 7-29
IhE film shows a radiolucent lesion and malpositioning of some teeth. The patient was an
gffit'ear-oldfemale who was normal in every way except for a marked hypernasality in her
ryech.
l. What is the radiolucency in the left anterior maxilla?
A. Fibrous healing defett (from orthognathic surgery)
B. Globulomaxillary cyst
C. Cleft palate
D. Adenomatoid odontogenictumor
E. Incisive canal cyst
l- Note that the rnaxillary left first premolar and canineare not in their correct positions.
Whar term best describesthis finding?
-{. Ectopic eruPtion
B. Distal drift
C. Migration
D. Transposition (translocation)

171
 FIGURE7-30
This caseinvolvesa 6g-year-old
white male who had an easily palpable
beneath the mandible. What ieim would
describethis lesion?
A. Exostosis
B. Osteoma
C. Mandibulartorus
D. None of the above

FIEURE
7-31
Each of this figure's lettered arrows
radiop-aqueentity. The letters appearbelo
the left column. Match each Gtter wifr
correct entity in the right column.
A Pulp stone
B Amalgam restoration
C External oblique ridge
D Cast gold restoration
Tooth-colored filling material
Internal oblique ridge

FIOURE
7-32
When this periapical film was taken, the
cone and lead apron were used as a
becausethe patient, a fully dentateiS yrn
was 2/, months pregnant. In your
which one of the following errors occurrodJ
A. Rectangularcone cut
B. Partial dentureleft in
C. Film placed on top of tongue
D. Lead apron blocked beam

172
 FIEURE
7-33
The patient is a 38-year-oldfemale who is currently asymptomatic.She has
generalizedmoderateperiodontal diseaseand shehad a fair degreeof calculus
deposition about most of the teeth. Biopsy of the lesion revealed that it
contained primarily fibrous connective tissue with some inflammatory ele-
ments.
What do you think this lesionrepresents?
A. Fibrous healing defect following surgical removal of the canine
B. Severelocalizedperiodontitisdue to local factors
C. Adult-onsetperiodontosis
D. Adenomatoid odontogenictumor

7-U
term best describes the two radiopa-
at arrows A?
dlu Antrolith(s)
M, Toms palatinus
0f- Buccal exostoses
lD" Fhalangioma

173
 7-35
FIGURE
The patientwhose radiographis shownhere is A. Cleidocranialdysplasia
an 18-year-oldwhite male. He has open B. Gardner'ssyndrome
fontanels,wormian bones,deficientclavicles, C. Cherubism
frontal bossing,and very few erupted perma- D. Idiopathichyperdontia
nent teeth. What's his condition?

V_36
FIGURE
l. Which patient-positioningerror was made A. To bettervisualizethe anterior.:-r l
in taking this radiograph? B. To bettervisualizethe mandib,=
A. Patienttoo far forward C. To bettervisualizethe maxilla
B. Patienttoo far back D. To bettervisualizethe antrum - - "
C. Chin too high E. It is never desirableto So Dr-r:
D. Chin too low oatient
2. For what reasonmav it be desirableto so
position a patient?

174
 7-37
fr-This would have been an excellent radio-
except that most of the maxilla and
tooth roots are obscured bv a black
uq. What went wrong?
A- Patient positioned too far back
B. Patient swallowed
C. Patientmoved
D. Tongue not againstthe palate
L. trf -vou want the shadow of the spine to
7-38
frl-[n a way, this film looks rather good.
lffbmEver. a single patient-positioning error
M qccurred. Which one is it?
A" Patient positioned too far forward
B. Patient positioned too far back
C. Chin positionedtoo high
D. Chin positionedtoo low
3 For what reason mav it be desirableto so
6@inn a patient?
move more toward the edges of the film and
away from the ramus, what shouldyou do?
A. Move the patientforward
B. Move the patient back
C. Ask the patientto standstraight(avoid
slumping)
D. The spine cannot be moved because
the relationshipis anatomic
A. To better visualizethe maxilla
B. To better visualizethemandible,espe-
cially the tooth-bearing areas
C. To better visualize the temporoman-
dibularjoint
D. It is never desirableto so position a
patient
 7-39
FIGURE
1. To the novice, this image may seem good. However, a single patient-
positioning error has been made in taking this film. Select the correct answer'
A. Patient positioned too far forward
B. Patient positioned too far back
C. Chin positionedtoo high
D. Chin positionedtoo low
E. Actually, no error was made
2. For what reasonmay it be desirableto so position a patient, if indeed an elror
has occurred?
A. To better visualize the anterior teeth
B. To better visualize the maxilla '
C. To better visualize the ramus
D. To better visualizethe hyoid bone
E. It is never desirableto so position a patient

176
fleuRE7-/r0
1. An error has occurred in the taking of this film which has resulted in a white
shadowin the midline region. This error is causedby:
A. Positioning the patient too far forward
B. Positioning the chin too low
C. Positioningthe patient on his or her tip-toes
D. Positioningthe patient in the slumped(stooped)position
E. A loose sideguide setting
2. The noxious, undesirable shadow in the anterior midline of this image
represents:
A. The ghostimageof the spine
B. An error inherent in using this brand of machine
C. The ghostimageof an iron bar supportingthe chin rest
D. The ghost image of the apron
E. A natural effect due to the thinness of the anterior mandible
3. Which brand of machineis this?
A. PanorexII (Keystone)
B. PanelipseII (Gendex)
C. Versaview(Morita)
D. X-caliber (Belmont)
E. PM-2000(Planmecca)
F. Orthoralix Oralix SD (Philips)
G. OrthophosPhos (Siemens)
H. OP-10(Siemens)
I. Autopan (Belmont)
J. GX-PAN (Gendex)
K. Rotograph230 (Fiad)
L. Panograph2 (Sanko)
M. Oralix Pan DC (Philips)
N. Panoura (Yoshida)

171
 7-41
FIfiURE
1. An error occurred in the taking of this film. The result seenon this radiograph
is typical. Which error was it?
A. Patient positioned too far forward
B. Patientpositionedtoo far back
C. Chin positionedtoo high
D. Chin positionedtoo low
E. Patienton tip-toes
2. When might it be desirableto so position a patient?
A. To better visualizethe maxilla
B. To better visualizethe mandible,especiallythe posteriorregions
C. To better visualizethe hyoid
D. Never; it is alwaysundesirableto position a patient in this manner

1 78
}MURE7-42
l' An error occurred in-the taking
of this
-_- radiograph.
-' can you name it?
A. Patientpositionedtoo far b-ack
B. Chin positionedtoo high
C. Patient slumped
D. Other-specifv
2' What is the iause of the horizontar
white rineson the right ramus?
A. Haircomb in patient's hair
B. Wires from a mandibular fracture
C. Ghost imagesof the left *rrid -
D. Ghost imagesof the right
E..Ghostimagesfrom the amalgam
"u*iig restorations
- This image seemsa little
3. d"rk il" reasJrn u.",
1. Too much kVp or mA
2. Too little kVp or mA
3. Fog from the darkroom
4. Overdevelopment
5. Film too fast for screenused
4.2,3, and5
B. 1, 3, and 5
c.2,4
D. 1.4
E. 1, 4, and 5

179
 FIEURE7_43
1. This is a weird-lookingpanoramicradiograph.What is the causeof the white
shadowjust to the patient'sright of the midline?
A. Patient slumped
B. Ghost imageof the apron on the left shoulder
C. Apron imagefrom riding-upnear the midline
D. A partial stoppageof radiationdue to a machinemalfunction
2. The object at the angleareaof the mandibleis:
A. A doublebutton clip for a turtle neck sweater
B. An earringon the left ear of a male patient
C. A ligaturewire for the treatmentof a previousjaw fracture
D. A foreign object in the patient'smouth when the radiographwas taken
3. When the turbinatesare spreadout, ascanbe seenin the nasaland antralarea:
of this radiograph,it means:
A. The patientis positionedtoo far back
B. The chin was positionedtoo high
C. That good soft tissuedetailhasbeenachieved
D. That nasalcongestionand sinusitismay be present

180
FIEURE
7_/U
l. This patient has five impactedteeth, the maxinary
right caninebeing one of
them. The others are the four third molars. rnis
raoiolraph- shows excellent
positioning.Where is the impactedcaninelocated? " 'r
A. Toward the buccal
B. Toward the palate
c. Hdf-way between the palatal and buccal sidesof
the maxilla
D. The canine cannot be located with this film only
l' why is the maxillary right centralincisor wider than
the left? (what is the best
scenarioin this case?)
A. The patient is twisted a little
B. The right incisor is toward the buccal
c. The right incisor crown has beendriven lingually
by the impactedtooth
D. The right incisor exibits macrodontia
E. The left incisor is rotated and thus appearsnarrower
than the rieht

r81
 FIGURE7-45
What error occurred in the taking of this film? Now we know you
know this,
A. Patientpositionedtoo far forward
B. Patientpositionedtoo far back
C. Chin positionedtoo hish
D. Chin positionedtoo loiv
E. Slumpedposition

This oatienthas a generalizedanomalousconditionaffectingthe teeth. The radio-

graphicfeaturesare pathognomonic.The conditionis:
A. Dentinogenesisimperfecta
B. Amelogenesisimperfecta
C. Dentin dysplasia,type I
D. Dentin dysplasia,type II

182
 7-47
patient is a 45-year-
'nr,ttle.There iS a pan-
ic radiograph and
periapical views of
mandibular left ca-
molar area.
fr-Shy did the lesion in
rnandibular canine-
regionnot show
n-ell on the pan-
ic radiograph?
A. The patient was
too far toward
ffillrn
B. The patient was positionedtoo far toward the lingual
C. The lesionis too small with respectto panoramicresolution
D. The lesion was not within the imagelayer
I ftJrat is the most likely diagnosisof the asymptomaticlesion in the mandibular left
@Mrmrc-premOlarregiOn?
A. Primordial cyst C. Centralgiant cell granuloma
B. Lateral periodontalcyst D. Botryoid odontogeniccyst
$^In the right mandible,the first and secondmolarswere extractedI year ago,whereasin the
mmandible
lffilMffi the teeth were extracted 5 years ago. The patient hasbeen on renal dialysis for the
1gplm:!'ears.The right mandible:
A" Appearsnormal in all respects
ts' Shows trabecularchangesconsistentwith secondaryhyperparathyroidism(renal os-
teodystrophy)
C" Appearsnormal, with normally healingextractionsockets
D. Showsevidenceof socket sclerosis
4 ln the maxilla, bony exostosescan be seenbilaterally,albeit better on the right side. The
l@r erostoses:
A. ^{re bilateral,on the buccal side of the edentulousridge
B. -{re bilateral,on the lingual side of the edentulousridge
C. Actually representa doubleimageof a singlepalataltorus
D. -{re more properly calledosteomas

183
 FIGURE
7_48
Ernie is a l4-year-old
boy who is unhappy aborr
appearanceof his front
There is a dark yellow
groove traversing the
lary and mandibular antcli
teeth.
1. The problemwith
teeth is:
A. Amelogenesis
fecta
B. Gingival caries
C. Enamel hypoplasiu
D. Fluorosis
2. This problem de
at what age?
A. In utero
B. During year I of ft
C. During year 2 of ft
D. During year 3 of }ih
D. Sometimearound
6or7

FIGURE
7-49
This patient is a 13-year-oldmale with a
ber of dental hard tissue problems. The
lary and mandibular first permanent
and maxillary canineare missing.
1. Are there any other missingteeth?
A. Yes
B. No
2. Are there any supernumeraryteeth?
A. One C. Three
B. Two D. None
3. The tooth that is erupting into the place
the maxillary lateral incisor is:
1. Dilacerated A. 1,2
2. Translocated 8.2,4
3. Still erupting c. 1,4
4. Causinga diastema D. 1,2,3, 4
4. The term that best describesthe maxillarv lateral incisor is:
A. Hypodontia C. Peglateral
B. Macrodontia D. Supernumerary
5. A spacehas developedbetweenthe mandibularpremolars.It is due to:
A. Distal drift C. Translocation
B. Migration D. Ectopic eruption
6. The radiopaquelesion associatedwith the crown of the impactedmandibularfirst molar Lsu-
A. Pindborgtumor D. Complex odontoma
B. Gorlin cyst E. Adenomatoidodontogenictumor
C. Compoundodontoma
 ';rilrirr:
t;i itrl

#w

GURE
7-50
- ": is l9-year-oldBilly. All of the third molarsand mandibularsecondmolars
::. removed.He hasa brotherwith the samecondition.Another
brotherand a
: -ir zre normal.His dadhasa similarcondition.Radiograph A is from I9g6andB
- :: 1991.
r What conditionis present?
{. Basalcell nevussyndrome
B. Cherubism
C. Bilateralodontogenickeratocysts
D. Undiagnosedhyperparathyroidism(brown tumors)
I Doesthis conditionusuallyresolvespontaneously or is it usuallytreatedbv
-- 3icalexcision?
-\. Resolvesspontaneously
B. Surgicallyexcised
C. NeitherA nor B
D. Radiationis the treatmentof choice

185
 FIGURE 7-51
thick and full. Her cheeksseem
Belinda has beautiful blond hair which is not really
rosy at first glance,althoughher face see_Tr.a littll chafedand dry- Her nails break
is now 11 years old and definitelv
off at the ends and d; ;;; grow out well. She
had an extraction' she has:
wants somethingdone abou-ther teeth. She has never
A. IdioPathic hYPodontia
B. Hereditary ectodermal dysplasia
teeth
C. Diastemai, multiple missingteeth, and cone-shaped
D. Incontinentia Pigmenti

186
mrRE7-52
Hsreis the one you havebeenwaitingfor! But wait a minute,this time
we want you
m supply the history. The typical patient is a Ql-Age,
rmmmndibular Q2-Race, Q3-sex; the
anterior teeth are e4-vitality, and are e5--symptoms; the lesion is a
Q5-Name of lesion in the e7-Name of siage.
l. The patient's ageis 5. Typically, the symptomsare:
A. In the 20's A. pain
B. Middle-aged B. Odontalgia
C. Over 60 C. Swelline
D. In the 30's
r. rhepatients
raceis: 3: X}"]IJ"J8""
A. Unrelated 6. The nameof the lesion is:
B. Caucasian A. Benign cementoblastoma
C. Black B. Periapicalcementaldysplasia
D. Oriental C. Compoundodontoma
-:. The sex of the patient is most likely: D. Adenomatoidodontogenictumor
A. Female E. ComPlexodontoma
B. Male t lesionis:
C.Eithermaleorfemale lltt',1-"il1"tn"
4. The anterior tooth vitality statusis: B. Cementoblastic
A. Vital C. Mature
B. Non-vital D. The diseaseis not staged
^
C. Vitality is not a factor

r87
 7-53
FIGURE
Examine theseperiapical radiographs.The pa-
tient is not particularly symptomatic, although
there is a history of odontalgia. The gingiva
appearssurprisingly healthy.
1. What is the age of this Patient?
A. Under 12 years
B. About 12 to 14years
C. Over 20 years
D. About 40 to 50 years
2. There is an abnormality in the mandibular
right premolar region. This representsa:
A. Lateral periodontal cYst
B. Developingodontoma
C. SupernumeraryPremolar
D. Smalladenomatoidodontogenic:
E. Microdont
3. The more generalizedcondition u'hr:sr
presentis:
A. Chediak-Higashidisease
B. Cyclic neutroPenia
C. AgranulocYtosis
D. JuvenilePeriodontitis

7-54
FIGURE
This is Joey.He's a f-
old active and smiling
But "Oh, his teethl" :
his mom. What gener
anomalous condititr:
fectsJoey'steeth?
A. Dentinogenesi--
perfecta,pitte'J.
B. Enamel hypo;
pitted type
C. Amelogenesisr:
fecta, hypopla>--,;
ted type
D. Dentin, dyspla-.r,-
type I
E. Dentin,dyspla.r-
type II

r88
 QUESTION 7_60
A panoramic radiograph on which the right
premolars appear widened and are overlapped
and the left premolars appear narrowed with
the contactsopen indicatesthat the:
A. Patient was positioned too far forward
B. Patient's chin was tipped excessively
downward
C. Patient's chin was tipped excessively
upward
D. Patient'shead was twisted with the chin
not centered

7-61
SUESTi0N
What is the most likely causeof a diffuseverti-
cal radiopacity that runs through the center of
the panoramic radiograph and gets progres-
sively wider toward the bottom of the film?
A.The ghost image of the spine that is not
erect
B. The ghost imageof the hyoid bone
C. The ghostimageof the ramusof the man-
dible
D. Movement of the patient

7-62
AUESTION
When the patientdoesnot bite in the grooveof
the bite block, the patient may be:
A. Positionedin a rotatedor twistedfashion
B. Positionedwith the chin too high or too
low
C. Positionedtoo farforward ortoo farback
D. Slumped,thus producing a ghost image
of the spine

7-63
SUESTi0N
:y the patient When the side guidesare not closed securely,
I Defect on the rollers in the automatic the patient may be:
3[ 'O CeS S O T A. Positionedin a twisted or tilted position
I tr Snaticelectricity B. Positionedwith the chin too high or too
Iow
I mm0rY 7-59 C. Positionedtoo far forward or too far back
,s ernoramicradiographhaving narrowed inci- D. Positionedcomfortablv
n'ith the spine impinging on the ramus
ririiili'ttmr
rnmmfi.ul:es that the: QUESTION 7-64
4.,,Fatient's chin was tilted excessively A panoramic radiograph on which the con-
-nrr'ard dyles are lost off the top of the film and there is
S Fatient's chin was tilted excessively an excessive"smile line" probably indicates
i.rn'nward that the:
I Fatientwas positionedtoo far forward A. Patientwas positionedtoo far back
I Fatientwas positionedtoo far back B. Patientwas positionedtoo far forward

191
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4. zysondi. arh (zysonutcprocess

of rhc
i:!drcd Y Thc noorof.hcnasatfossaandrhc
?!llarysinus rhcrrmsofrhc hno
. rid rhebony'!sembte
watt$parrins de rwoiuc
:-\ rc*mbrc5rhete8ofrharter.r

2 A stobutobarillary
.yn
I I ptrhpicatEdnutoma, $rsi.d dered,
t.rprcaL cy{. orp*6pical abnAs

{. 'rheriierior na5at\pii.

:. Themedia'rahrat5ururc

ourjic orrhenose
: Thep€ipherut

L zyEomli. p(ccss ofrhe nrxilta

. ?, lrreiorborderofrhezysomaricarchrhr
I Theconicilptareot rheanrernrpatr
I Th. maxillary
3nrrl mucosr 4. Thecoronoidp'!ce$ of rh! maidihh
5 The mediatsighoiddepr$ion

Thk is rheincGivctotumetr
(nN,p,tarincfdr
Thecofonoidprocesof rheha,dibte Den) A\ ir apFe!6in rhG,zdiug.rphir coutd
be incodectlyid!ntified.s in incnivc..naL
l. Theexremdobtique
2.lhe 'idec
obliqrc ridse tmll$.rl
''refl'al
r Themandibutar(inferiof alvenrn!!r
ThcdilTe.snc!
i\ in thc.nsulalionoflhcx{ay

1 rhe co'rird pl.rc ofrhe owcr bord.:j

L.ThezyEonalicprocesofrlt nLrirrr
2. fhe sofrrisle shdow of rhe hamdar

'fhc arow\ kc rroi ins ar rhernreriofh. ?

orrheronlue.Tlreiilmw.rposirioned o\erf!

I. Lrrerd walLolthc dNLLtn$a

:. Mcdi !r olrhe n rill$] sinui
The mentallo[men TheE hasblcn I grcnr
derl or bone.!sorprion.rd rhe menralfoi! I S!p{rorroEmenof !h! incisive.sn:

Thish a naxillarvrnte orocdtrsrlrie\

Youre corccl ilyoi \xid ftnnrhc mandibu

lrr rntrior ailr. The iexr coiiecrais*ef i\
rhd (l) is ihe slldo$ ol rhe Loss lip fhc 2. C.nrLolrhelingualrdcfyxtrJv.;
tuundrndiorrqtr!arer n rhc scnialrtrb.,tlc. r. r tdor0lerotrhe nxndibk
wnh lhc lin-qualfonme,sho*Ltrgas a \mnll 4. l crnt'Lobliquerdee lD!iLohlold[:
i. Ertonllob iqtreidge
6 Solrli$ue ofrhe kitre Lip
7 Sonrisn'cof rhetonaue
Th6 n a,mrnJibularaderio. occl!sJ \n-

I Thc subn.ndibuar losx

r. M..dibularrasr lsreioidlb$rl

4. zysomaiicr(h (nrbr bono

6. Pon$ior $ill ol rhc muillrrJ-\iru.

L The iireio..o(crolihe mardible 7. Zysonalicp'acesrorrhehnritLx
]''lhe\trbi'andi|jtrl]rfN$ 3 Gho$ lnasc ol {he coftrld.,ri :r
I Thc mandibtrh. (ideriorarveor,,rclnxl
L The itrr,iar o6ltqucidge (mytohyoid
10 Floorol.h. narillrv sinus

242
 | | Am e o r $ . o tr hem ith.ylinu! !r 26 Mnndibul.r(inlero'alveotan.inrL
:iLl {aLLof thenasaL fos!d)
23.Anrcior ruberchotcl
29.Medid signoiddepressbn
l0 soll rissu.ouniic of rhelips

16.Panonmrciinomidar Line
pmce$ ol rhemandiblc
I CoronDid

le Po{eiorbo'ddof rh! rrmus

lr Arrcriorbo erolrhepancentricpdl.nr

ll Choi imaseolrhe R mr.ker

:r Dodyofrhe hyoidhone

li Mmd htrlr(i.fcriorrlveolar)crtrd 9. Citcihedprrocti.oid iilrmcnr

:6. chon imalcofrhe _L marker
:r So nr isu e o lfte erlobc ll lonertordinoidrfocc$

10 trk(.malobliqueridEe
I F.*chal Ndirory can!l
i varjdion of norm.l rcrR$nriDga de
:kiion in rhched of rhecotrdyLc
5 zysondic rrch (m! !r bone)
6. Ldetulprerysoidplare
r. PoneriorwlllofrhcmuitL y ! iu\
rJ Panoram'cinnomharcline
r0 lnferiorbod.r ofrheorbn
rr lifcnor borde..rrhemdiLhry sinu\
]] Acrunlimaseof
rhcrighrsideofrheha]n
i6 c!.ebralrrrrce\ofrheo'birrtDtftes
ll. zygondic prees ofrhemarill
r0. Hardpdarcdoororrhc sinug
2r. Pr'ysonlxi ary [srun
r Air spaceofrhcoNrhirynr
:1. Dohrl su'{aceollheroncue
14.Anreriorruhe.chof$c d as(ct)
25 Ododod nfees otrhc rxk lcl)
27.PoieriorPhafyigcat
{aLl
r9. Bo'ryofrherhirdcefricatvcireb,l
l0 connlunsLeofrhetcft nlidibt!

1.1.
Gho{ imaccofrhekft \idcollhe ftLxr

lr. son rsue ofriDol rhenose r. Lrkftl bod* oflhe oi bil

r$ Prcrygomarilla'ynsurc
r9 cd,onoidpr€essofrhc mandtbte

] Poi.rior bo.derorrhcnmus

:r. acruarinue ofrhe -L- marker

:r Dotrbreimale of rhe body or rhe hy-

rj. Exremarobriqleridle
 14 J.id besleetrct andcl

16 l]oof of rhenrsatfosr 2 Exrern audiro.yme.lus

l7 zysomari.arc[ (na]4 bonc)
ll ododoid rro.esofc] 4 rnternalatrdirory
cant
r9. BodyorrheDMd tc 5. Hqd oflhe ndndibutarrcndy
c

3. Ansleotrhemandibk
9. Medi.l rsruc(orrhcmandibdrrnmu.
r0. Poseriorbo,d.r of ha,nDahi€
ll. cotunoidprocesormailtihh
r2. Anrerio.dhmoidak ce \
r colmid Prcfts or rhenaidibte
vlmtr and p*pendtq,taf plar
.r.
t hieml bo.d* of rlr o$n -
11 LderalMn otDratrbsa(nldiat*!u r

15.Lflcrtl $alt ot nuil|Iv sinus

r6 zlsomdtc nfolcs ormari i
rr. zygomali!a(h lmalarbone)
rJ. Ponlnor dhmoidan.eth
l| Odonroid
pmce$ otc2 r0. odonroidDroce$of cl

r4. Pon{ior bode. oflhe {nus

slrdue No l7, rhemxtubme. iho{\ f:l
r 6.lo in tbd q c.ncr dd c:
n nqcr crpontresrru used.in.Lldi0g3 J:

stcTr0t'/2
adnnbrrdotrGeniet Lum.otrr.I hir Nultv Pl'drnqiona(parie.fs linlcr)
occn \yhen.hehorzonralansh ofrbc berm
6 nordrrcrd ihrolehrhecoiucr2rea\ofGe
r.dh being.adrcEraphed. Thk ..off rn,t.,
may be in I nesid or diskr drlchoiimd
cruscsrhebuccalud ltdgual5lsneic ofrhe r. The sporon ihe ctr hrnd siden o.::
( r .4 po r on r f rhe,e!rhr.4ooesr ma*fi.mlhcpmcc$ing krkr$e spor.r ::4
ru bc
.enxJd Thi, FodlR5 d rcrirr rriutu
cencj-riar n.y b. mnkkenJbrcervi.alofruol
..r1A AdtrDhnrionmaribe ideidliedby rhe

while rheJiknvN ii.he dcvcopinssoltii-r

run c i r c, n,pcrrq, A he rtul r ru;p sndtr4 ritDdB* b n. o{in! b !,darrr
ron Ddwecnrhe.rot .rs,ontvoncitcora
 fiLn dofth .mulsion*!s proce\*d in rhis
ftr: rh!s. I tishrefihagesis produced.
Handtins ot $c tito wnh flmrjde.
.onirninried lingc6. conumiiarion fron de
veropersolulon givcsrhesam.Esuhs
Thn indicares an inproper hodzonhtns-
hrior ofrhc radio*mDhic beao in rttrdo;b

l.
_FiilL,r b Drce rhe fith sunioenrty conemrularions_yooie,isbr
ityou s.idforF
l. lMdequare ycnic,l angu ion of rhe m

Thish dueo djncnsionst dht0dion,whichn

m mie , c d $ ro r* h e n rh ch r. h -s . mg k n ,
Br-tollute ro cipose rhc fitm. Th* occur when
rimeexrc$rcbunonn nordcprcsedlotrs
'he
The nln can rrso rurn our rhis lay if ( n
.'!c'd-nfarlyDlacedin .hc nxcr \.ruri.i fir{ Elo4dion. Thn cdof was madeenher bv
u'ns posirivevedicatrnqirioi
Thc im4e is rhei compler.tyliped on.rhc
ofrho'nadcqure
mdlosraphic beamorby f.jiins ro have
rieabrmsus ptrneorsctu$t ptancDarulcl
rorhefloorii rhobkecltnsnnskrechni;ue aid
rhennorusingsdllcied Njilive v.nicd rncu
rarjonofrhc ridiosBDhicb.rm.

I X{r} no.hhe norencnr

n roo Norerharrhh s.mcrnifad occln a1r resuh

I Thisecur if rhedeveloptrsoturion
*mm. Th. oprimatrcnpem!re is63!Fwhei dlcrimolnsofrhciilmr\ rhr fitmn han,lt.dor
marurrproceshs soldioture used rcnovedtromrhena.kerberdcprocesins

Thcerorirnrgnifieriotr,whicbirftrhe,nr..
n A Nurly \cunwhenrhc 6im ro-obreddt!
rmce 6 a.d a divcrFnrbcm such
as cxkh'ncreased
ln someshon o' poi .d cDnc\ \
Ii.sriye curvi4.f rheponeior hatfol rhe trsed lr dso o.cun as
a resul of drchinc
nlm.whichis usur ydue ro.xce$ivc dignrl frovemenrdunns
pres!ru b) cxposuE ot rhe ritm.Ma
pdienr rs hc is hotdnp ch'n! mov.mcnrcru\er m efi*rivr incferse
'hc 'he ue Qrgd szc. rhls produciDsrmuniied
'n wnh! fuzzyourline.whirhnduciorhd
'mage
incfeaiedpenudbrarhar ooccu6.
I ForesnoieriisorrhercoBjnd o.nm
Niion or rhe zysondic dch orer rhe;ril
l. rB't6.ient.rPKE rinc
I trx.csive posnivevenj.d msotstion 2. Insdtci.nr nllurnpcnSe :cfri4 (nl{s).

205
 3 l.sdlli.ienr nAs ldor relarivero rhe pa

4.Imd.qu e drYcropncnr Nore rhefilm roecins.shich mnybe produced

5. Wcrk or depleredderdoper loturion
6. Ins!firisr knavoft'8e
by a lEhr leak, a safclighrrharis roo
cros'larkroom
to ihe mun@rtop,atrimprop.rfill( on
rhesalelisht,a scdcnis ol se.ondary
tion,chcmicaLs, orihe asingol rhe6ln':dii.
(our

2. rhmughexcessivc posirivcvcnicJansu
lalion of lhe rtdiosmphic beaD rbc flm Ms revencdwbenplacedii rhe pa.
ricnasmouth.The ub si,l. olrhe 6lm packer
*asracirsrhcbeam.-thexrayswcr.pr(ia ly
nbsorbedby thelcd backin!rthusrhecharac
r.rsi. rire trckJ o' _hedingbone prr
tm wasrronucedon rhefirm.Theilm rherc-
lore appea'rligh.,undeftxposd,androesy.

The .an.(ua11ycomeotr rhe folLes

'rbbertoihe procosseJ
rnd adhere kdiogrdph 'fhe lowqedgeol thelilm *as norpla.edpr
lf you lmk closely,you can aho sec laric alleltorhcoccbsdsuacesofrhEtecrh.Adu
eleciricity sup.dmposedover the melal roor rhc nlm w$ rrop.
eny phcedbur wr\ movedby thepdienr.jui

Thislineis ndiopaque.Bendine$cnth dini

caly produ.esa lineGeerhe.oD rmdcqmrer'roiton.T hculm!s norLenlnrhu
'zdoluccil
Gn co.ne.ofFig.2 l3). Thi6rni&cr is pro. nxerlddsenough aner developmenl.
durd in ruronln. proc65ing n{hines. The
c se ot rh's occtrflenc.is nor well tridc.
imd. but ihc allifid prcbabty*suns irom
u{c or rhebenredgeolr Jitmas rhe lcadins 2. srongeor$e ntn n a wnn ptace
edeein the nulonaricp(icc*dr. The raaecd L Erpontre of the film ro srder rdi'rion
cdseinthe low.rilhr hrndcornerrcprernh 4. Ughr leaksitr rhe darkroom
5. Excesivep'oximiryolrbc:elelishrrorhe

6. Improper nlrriion on rhe srrelilhr for rhc

i.lr sas ov.ruxposed
ro Fdiarion. 7. Useofloo irong r bulbfor lhc salelishr
r. The dcvcroper$turior was inpropfltri You knew rheie. didn\ you?
0ixed. so rhd In oveFconcenrared Say Yes.'
solurion
srs imdveftiny Droduced
4. there *as r righl tcdk in rhe ,iln.
L A neral or leeded gh$ ldgtun. em
bcddeditrsoLlhsueovedyinsthelesiotr
2 A ncirlri. objecrl$ide poin..d cone
oyedNpping or ihe .onrds. This crrcr vas '
madebri inlroper horizo.lrl rngnlalion ol rhe 4. A mdd rngneir emhcddedin rhe bone.
whichn rhsca(seolihe lerioi
In racr.rhisiadiopaciry
repr.senr\scrirched L Fliroreio nt rhcd.vetopsetulion.Thc
emuklonoverihe \uperirforancnohhei..i- solurionwas werkerxr rhe
rop rhm riflhcf

I risufici.nr solrtioi in rhe fircr |rnk. The

trpperpoooi oflhe hrm*as nolfixed.rhus

\.livlry gLand
dudr.dd sode radiolucenr
le
Thishln wasrhcedina manndsinitrrorhd
ror m occrusat ntn md BN rrken.r I hish
rnsr., so rharft rs.rblcs a peirpicll vics.
r. Air btrbblc.wirh impropflrsibln)n th. when biriison rhetitmpackrheprrienrufd
bubbleadheres Io rhe\urraccorrhcfilm. excc\!vEro'ce.$ rh.r r rhepoinhof conr.d
Thk ponioi olrhc nlm is 4or evcldDed ol rhc teerhrhe lilm en,dslon!a: crimr.d
Thc radi.rucenr_lcrionlike lnifdr ap
b. Son-ti$ue crlcincrrion3

DeyclopcrspLa\hcd
on rhe film Dndr ro de
Theleares6ells ol deeelop..fromr dip rhrl
Be surero lash rhcfi1mholdinsdipr rhor
oushlyir clearw!!erbclorcrcuiingrhcn

Theparienfs
ume wasw.nrn onr[.to .f
rhcpa.ketNirhrnoinmybellpoinrpcnpnor

Ir ydu srid dcrelop$ rdifccr. you re abjo

I f,lc.sive po6illv. y.nhll rnsur ion oI

well. ilyotr choie fix.r rnihdj ,otr c nor

only sh!,burnowyouknos yoDalsoLerrned
Rerior'rior.ThG i! ! cru(kinsof rhr film

krrempenrurc{a\muchc.olerrhanrhedc. Denrure virh porslain reeth lblt ir rhc pr.

ldoperandllxd :olutionGmpedures.

2t1
203
209
 r-iDi $ppt lrd se o d{ irni i-

r Mi$rr
audn r@m s4r'r.d

B!{ts933ibbreldLldolu
 D o n j d d [ o r u l h y c q i b *o d

! !:4d!r,,m4!4ps hed
b h$ oI .h. api.el im.8e of rhe mai_
lary or frandibuld teeth
I rhep ienasbcad *ost :rcd, h. A DFof, nn6 on on. ride of rhe ih
:. r xrm* ree.hononesideotrhe
andEidqrcdhonrhcorheistde :fiflfti:J"'"'""."'"
"""'"""

r or rhr rior hacc 1 rh, mandib

uL;$
c. b$ or r|ll rfir\ ofi lhc rop of rlr
http://dentalbooks-drbassam.blogspot.com/

I r Rere6esniltlineof 0arocclusrlplde sbrdo{.d thc m i aq aricc:

b. Lm. orthl lpi.ir inlae !r rhc msit-

l lhe palientbcnrrhc nsk*hile cumpn{ ]Supcdnp6ilionollhceho:tin'tgcofD

rpinc in lhu a.lcrior midlincorrht imag.
 NorsThep ied rh.ltd bcasked
1ohokirhe
1.Nrpkin .trin or rc.k .hrin eror
L Sop.tnp$iio' or T iny.n.d v{hrped
Oon imsg. ofth. chrin in thc anreriormmdib.

| . Noricrring ,r hod€ b,&

2. A po{ionorrhedrn n blrrr, r por.
tion or rheirrge or rhejls 'nd
ii nisiins.
I Filmeipncd ro lisbrbeforcproccsins
: lmJlc nilon lighrexposed p.non or Nore somc ma.hines rin b. acrivared cven
lockihc dtkruom doorikcep
*hen rhectrsene hrr nor bcci roraled ro rhe
iLd. Reocmber:
involvinsrctu[r lishr! s.prrrredliom
^drk

L Pror.dive rpton shonldersbrp ,nifld 2. r whcnrhecrse(ehnnss up.usurryin

I A Shoir in'ge ol erch or tte shoulder ann.m orclorhinc.
rmts in rherightrnd hn mandibdarprcnolar
lhenashincnoDs

nrchincs. lhe sl'oulder cd brnd representi4rn orercxposd

nmps rcndro idc up ontorhe neckinro rhe
|!rhorlheb.amlhenrhep.ft nrs sdownotr b. walh suhs.qt.n.prtienrmor.ncnrj

Norc:Cas.re hrngurs rnd pdicnrmovd,

lTonguc'n{p'.c.nor
:. A blrcl horizorlrl brnd obUlemra rhc clorh'ns
or ro rde,tulrcly
exp[in rhetundion
Fnrpidr resior of lhe millrry reerh,
 sFinrdd oi ndrhc Edor d

fudibtud|dfcd&o.6|n,

216
 cdisds40e;ou d0n

EtrorNo. r: Frrn roolishr(iowdensny) Efdr: Filmi@ drk (hrshdeNit,

rfrhe imaseh richrwnh poorpcnerarion of ollhe inase i5 dark,rilhbumour;irhe \.n
:ie had lhsuEsandsoodsonri:suederail visualizarioiof .hc hr.d
re nA may also be increaEd.(I'led kvp co,7?.rionrDecreaskvp:in s.me machiGs
for Laicx ReslarS.tuenskabour t5 ro themA mayaLo bedecreascd. TheLsualfr
-.!e mrchineswirh Kodak
Lrnex Readar screens aid T MAT-G 6lm h
Fllr occrusdpLaie
:'deied inre'condylardi:rana, iicftased
r.nsiry of rhehrd patarcshdow,loworpo-
rlon orrhehardpt'tatesbldow. Eror No. 1: t-i8hrlc!r( bollon ot..serie
the chin \@h rh.r rhe (matulibulrr 'i
rishrnd noLrarea)
sRnkfo4 ptanen dovn 5 rd 7 degEcsluf ,r /3 e ./'4,?.reri' ri.r: Locd ize,l high.densiry
rn[on'ns ligh. be.m supp]lcdwirh rhena aroawrh rhe blacken pad ar the edseor rhc
:hin. U$arryrhettshrbeansh.utdbe pral ild wheF rhe cr&k in rbc ptasi. .asene
 Eflo' No 2 Norsbnil8 ir hdne besc
scrccn\mry oftenbe rc.used.otrc ofrhc ad. r,r4P .ra,?.r.'t/i.ri /rbour r njch d :
vanr4esoi ngid prnomniccr$cnes n $d kft'hand edseof rr'c nlm (calienfs
'tchr
,mrcc a sharleroying ro bdier iilinncrccn cokrric,: AILma.hi.s haverdefliilc be=:
n'trgno'n( Ibr rhe r.rartuncycte.ard nr-i
E t r o r No ]'chii|oohigh hrvea markcrrbrr shoutdbenropenyaLrlpr
hdorebesinnitrg
lhcexposurt.
wi&ned inrercondyta. dnh&c. whirerrnd Erlr No.r. Parienr ist*nrd
rhiqkcrhardpardcinase:rhehJt lareim
4e r p'ojc.reddowtr\yadonrorDdobscur's
rhcapicesoflhc nrxiLLayr.rh c,r,!.rtorr Cro:erhe\idcsrtdcsor remtsr
a',?.,io,rLow$rh.chi'_wirhrheltmkbd 8trides.rhu\ ci$ring thd ihe p..ie'r n T
prrneai r down ansleof 5 !o 7 desre\ or
prfu lel ro rhepaliemposi.onir!lishl bcam.

Eror No r. Birr s denoruled

Sraric ctccriciry
!r$es the prccipnlrtonotsilv{ in rhe fitm.
rairni4varioN pndflnsthararcbhrk ordrrk
6larJ\ccirrotr
e x er i .Re fer b ackroristrreI
,,43(.rak..?rftrrr: lhe rerh aE ii or;:!
sion.rvhenrhebileeddei\ nortrfd.1h.( ]
nolry bknow ihhc paft nrErooli'rrbBz-r
or brck In lhnca\e rhcpariente.dc'l !r rr:
larbrck,asc.n besee.byltr:Drcadingorr
rhe rurbirrre{hlilov and su'rouidii! bl-i
an sFcc (medut ffod rhe noser.hs:r

C.,?.ri,,: Userhc bile suideor bire !\t!\r

i. creynh chenicalsntrdge andaskrh! paliemro bncin rhesroovr
E.rurNo. r Tongucnor pdde
1 Hrmmity rhe dr rcoD. esDecially in 'grini
w'nrerrhetr rhehFred Inn dry. greyrh irra'lowrbove rhe rpicesor itl :.
r. srrndonananlndi.rftbcf mrorpadnr
lilD loadingrnJ hrndlingrre^. crf..rt ri A\k rhc Pdicnr ro swalto\ :j
r. whenaDe* boxofnhisopened.rhculrn suckon hisof hcr cheekslnd ro.sue.or (if,
n richrlyprcked Aroid s l. rcsul{ingrtum
irictionbynorptr insrh.htmfronthc bor roo

4 Avoid ptrlrinsrheririn,ron rhr casre(e

r mlch widerrhairhcrrmusoi droDp.::

F.ror No l M'xiliry projheln hft in ,F ide. Theponenorrdh,nayaL$ be*id*:a

Th. pa,liat deniure ran0n rh3orhersidc.The body.r(hc hr.r

! | e m J h ,\ it'eotr' bone
.,,(,r,r Metat ptunhes.sshoutdb. re
nov& prof b hking rhcndiognph.Thc pa.
is widened.nd sprerdou hoiromatr :,
.h. sidewhercrhcr.tmtr\i5 widencdThr:i
4br...i,", clo\e rhc sidesuidesor remF.1
 nopplce.The caseuemay havchuneupotr
thepdie'rs \hoold$ormorelikelysomercm
EnofNo L lingen.il Mihd
black crscci! ofclorhiru Thc erposure abonedshonry
,trd!. .h.n( zriri.Ji Smt'lL.
iherarte', as indi.aredby"as
thc uncxpordlilm
at the rishlhandedccolrhe film causi4 rhc
ao'1.rt ,, Thn eiror( not .ausedby 64eF
orilsburhy cimpingth. ilm uponwrhtrruw
bulky henN or oveF
iie n rromrhEbor orcasete orwhDdpushitrg
dorhins,erpccielLy rhose*rh paddedshotrr
ir bo hardintorhecasenc (miLilary)
dfls, or eprtrleb or similaritemsor
€(orNo.2 Nornrrti4 al hone bdse jevelry or rrshiona..esso'ieswornat or on
/?(F../rz.r.trvi.iA blankdca arrheletl
hrnd ed3eor the film and I pfopod'onarc
iFUm of the prtienaslnatomymisnngo.
ju$ dhraltothe blackline.
anl7..ri,ai All mrhii.s hrverdeinirebc-gin
ac,lrti,,, Wher \ott cr$dtes a't used.thc
iiis poinl lor rhc rorarioncycle.rnd nx'v
hrle a marrerrharsbotrldbc proptrly gned
upprf.cfeennippedup wirh .herhtrmbto re.
b.forebesinning Iheexposre.
moveandreplacsrhccxposed film.overnn.
thls cracksthe sreeD
cricked.ir doesno! iuores.e rnd theRloB
Etur No 1.PmnhAisleiiinrhena ible producesno inrgc. The screensshouldbe
,&,!z .r,,?./.r.kri The rsclhrnd tr!'Lic
$nhd,awnfullyfromrhe!a$dt. andsenrly
Je.rurebasecanbe *en Adurllv rhi\ c.'o'n
liied up wnhoutbendinefor lordinsrnd tri
nor so bad,espesially ir leavincthe redlr in
rsnh inpaliemposirionins andheLps ro$r
l.ilizcrhcpnienr.Nomallyporcal n tdb can
F.renandanyrhiisinacryl'ccannol bess.n
on Dre o.c.sion\rcrylic.!n be :eenshen r
rhlckro\rsecrionisirased (NolDrhcacrylic lirorNo. L Chlnroohigh

acr?.r,on: Removerhcdcniureifrhis G con ilarwirb rh e B a rc s h a d o * rh i. k c n e d a n d p ro

tu or No. 2: Tonguenot 4dinsl rhe prldre
I'nds? th.n.t.thtnr: A drk sl'ado*
ihorghoui the daxilla at thc lpices of th.
o/,..,io,, Ask rbc pdieni to $varrov lo
,uckon theroneueandchecks. orbothdtrinc
Etur No. r. cbin too high
,,rr1.ha,?.r.,'JirJ: wideiedinrercondvl!'
dahnce:narocclusalrlaie itrmax_ Etur No 2. Lip! operlnd rongueno. ssdiir
espE.iiLLv
hry redhi ndndibularedenruLous !p'
ndsc
jecre'rdown omo rheapicesoflhe mrrirrry
teth. The rooh olthe narill&y lcnh aE ob
$urcd.s rhcyrrc ourorrl'c lryer.The inter
coidylardisr,nce sv'dened.Thcimiscojrht
mandiblein the iooth.bsarii-!lreas is im
provcd.csoccially itrrhcarreriorre3ion.
car.rrirn: Tix rhechindosn NirhrhcFaik
lod phneonr5 roTdcEreedo*trn'slemd/o'
p$alhl b rhe machine\ patien.poiiriodinc

a/r..ri,tr: Tip lhscbir downwnhtheFrank_ toDsueis do.lcains thepalare.

rhelipsrcnali
ron plandon a 5 b 7 degreedown ansrc Alietr an undesiroble an
rlreDosnioninsbe.nsnhrhe Frrnkfonplane spare atuundlhe

co,..ri,tr, Askingthe parie ro swallos,lo

L M,chine {opped, exposnre suckon th. ronsueandcheeks. orbothdtrnne

t'rds. .i,z,r,,nrid, The ,ld.l venicalline asrini the palateand to closerhe lips. Go
ii ai rrer ol overeiposure due ro machine ahe.d.ty irl It redLywofksi
 aiea such4 ir a .loscd druwerin rhe.rt
Eaor No. L P.rLnr Dov.meni roon, rhc aM *bcE lhc .rser. e
/,a3p .n(.,.rariri'.rr j3 'n
Movenenl be! de
re.red alons .he infeio! bod.r ol rhc m.ndi- 6. Chectrhee&i6tion dareon rh. bora
ble. Norerh. pari.nfs righrmandibutar lhn,t
fi16, Olrdaiednh day app.arrog€ed
dord eson. The bluftjns scus rhrcush rhe
tull vedicarhcishrof rh. fitm bur G mon eaity
noredarrhcinferiornarsinorlhc n dibtc. Edtr: This n whd h knoyn 6 a hybrid.|E
co'".rtni Ask rheparjenrmr ro movernotd r sucnu hsonce so mE orbin. ro f-
neady:norro ssdlowiror !o be at4jnediin I ne{ lppenne.Thison€ h rcrmedcbtn.'_
orher words, ercouras. rheDari.nr.
orh.r eiio6: Tongu.mr q.ind rh. prrde! ,uas. .^ar4c!.ziri.rr Thc ectus! Dtan.i
nor d.rtns d hone brs,.nd rrmn lnltrd, f,ar bur becauserhe Darienth roo tu 6fla(
Thes wqe nnor, bd qe k;o* rhd you $. 'nrer.ondylar dhranc., i'scrd of :F
ho, hoB ro sporthesetlfnor keepgoiru peariryqideie,l, becomes nomat. Blc?,E
soF. at rhesewilloccura.ainsoonl rhechinis up!ther.srhappearnuch k$
rcwodi ev.n norml ar rines. Tho spine '*a
ho*ev$. sup*mDosedon rhcmus. indi*
ing rhe t@ far loNard nosnioningeror. TL
conryeft realuresare rhespineand flarc*
/z.r? .r4rac!?,iri.rr Two ser ofrcdh, one
of a child and onc ofd adorescenr:and a dark a ? / u ' , . 4
T ip rh elh m d o b iih d e
{itD be€lsc the 6h wds elposed rwicc. rFd ble ,n rhesro!. itr $e bnebhrr' h e| , .
C,rz.ridnj Ar soon6 a film hexposcd.rc- rwo or.he posirioniig -
movc n. proa$ ir, and El@d .ho cassere. lishls,The fin! shod
bealignedwirh the FranKon pbne. rh. sec.rl
This way a closedca$etro canconrainonly an on vedicir
a linewirhlhe m.xittdy clnine.
uncxposed frlm.Did *e ser yau on rhisonct
weU . . . you e noi rh.6Br-rhis one *as
Eror No. r. Pr.i.nr turili.d
/,rng? ./'dra.r.iirnri One side(hero rheF
ri.nr 5 ish0.pp.ar nom andtneoppa*
sideappeds to sloF upw0rd.The inferiorbG
Inaqe chnn.k ilits : Tn ovean drr of th. Ieft mandible:topes moE dr:@t
is sry and rhe $turures s. . ly 4ward. and rhc condyleh tor ar r-
upr.r frarsinofrhe 6ln. Th. occlusalpt&
maylbo $opeupsardon rbe-up'side.
L Checkwanrs.ofsdelishrbutb.0r sholl,t cbz..rbf clo$ rhe ri'lc suidesi atisi rL
norerccedl5 wa$forLanex{enslive6tms.) midlin.posnionins lisli bean.
2. Checksaterthrturer.only rheEd cBx Eror No. 2, Pirienr i5 sushdyim flr ba(r
or GBX2 filrer can bc used wilh Lanex. /rdse .tara1!dn1'!i.ri The body ol rhe hJd
hne r sprcadour and *iden.d. This N..
L checkrhesatetishr disuncein shoutdnor vhen rhehyoidbon€is ii a rerudedposnE
be clo*r to .he workins surfacerhe 4 feet. Thn can occur whcnrhe chin h roo toN
l' Chek rhe rcom foruhirc [3h leat5 by whenrheparicmk roofar back rnlhis pani, -
ur$ c6e, rhechin h nor @otow. as cann
Innderhe drRrcom. Loak for arc6 of Lshr cune of .he occtd
k'rmg espe{i,llyrodid doo6 or orh.r
'n.
c,'ddrd,i Move rhe pari.nr fofrard. a5t4
5. Check lhe rilm noDsc area. Fitfr shourd lhe parien. rd 6ne in rho
s@ve jn rhe tiE
0c nortd . retriseraror unrit lhe box h block, Ako the caninepatienlDosnjonitr! lEr
opened. The 'n open.d b.x sbould be ruck.d can
be uscd ro .nsurc conecl fooffd t-t
!.fery a*ay itr a tishr pEof and x ray_proof

2n
Enoi ws noredrhefoltoringEroB
2. Tonsueior on o.lare
lnyque*ions?onlyoneleft,so {c if youcrn
E(oi M,cbiN olt ot cetibrrion
,,a8c .ldrd.r.iii'ri.l Thc rop pafr ot thc fitm
brank,aid a prcponionalc.mounrof rh.
's
pa!.nr\anaromy h disingar rhehoron or
C,,?.rtotrr The .ubc head had bcci kDocked
o.hirinadveftndyandpusheddo*n*adand
od oralisnmsnrwnh ihe film .nd palieft. A
bncfiervicecallnxcsrheplbhd,
I s.cpr Ior rakinsapanonmicfiIn
A. Bircinsrooveofrhebireblockor bilc
D. Srrndpr.ienruprighr
E Swaltow,hotd,expo:e
\ote The aboverqiresenha s.ncfi! rch
n'quewhichisbasi oall nachines. Eachna-
rhine manulacrurer incorpoFrs rh*e basi.
n.or. arrhoushrlishrvadaiionsexij,$ rhey
do fromone brandofauromo6ite ro amlhcr
onceyouknowhowbdrive, youcanop€ra.c
3ny kind ofauronobile.And so i! is in pan
oramicEitiolosy:Onceyou knowhowio or-
.dronenachine. il\earyroteamhd*iouse
:. Ero6 asociaredrilh eachnep
A. Birein gtuoveol$e bi.eblockorbne
(Thesnove is inlhcplanicbir block.
usualyon a pon abour? or ] inches
aboveandin tronrofrhe cenlerotde
i. Paienr roo tar lbNffd
Pahenrroofr b.ck
'rhe
'i. hrn machinAhavea vflric,l
lightbmm rharshouldber tsnedwnh
rhemaxirlary c$ine 10checktor coF
ftd posn'dnins in thisnop.
(sidc&ides nay exrendup fron rhe
chr re$ dea and rcn asain$ lhe side
0t thejar, or rheymayexrenddo*n
hoo rhe bpot.he machine and cs
asa'nnrhesidesorlhehead(enpoml
gulllet rnd soherimesatso rhe forc-
The ralcr machin* have a vedical
l'ghrbezn rharshoutdbe alicledwnh
the hidlineofrhe parienf5tr.e (mid-
(Thochin €$ and heishroflhe aa.
chrnelre used!o rchiev. rhn po
sir,on.Thc occlusatDl.neshouldbe
or a downanslcol5 ro 7 desfe* ro
cored ior rhenp angleof 5 !o 7 de
grcesred for rhe bcan in a[ pan-
n, chin nol on chinren
The late{ nachineshavea horizon-
I y onenredliehrbeamlbar shoutd
be aLrsndwnh $e Fnnkron plane
(al.rraru! linc or similir anaronic
(Theparienfstcershoutdadvance
ro
sll or hcAelf io keepflom fatLiDe
rrackward.AhhousnrhjssdemenrG
a slighrerassenlidn.rhe froro ad
vinced the parienris wirhinrhe n*
chrne.rhenoElilelihood.heren$rr
rheneck$'ll be straighr.)
L. slumpe,lposirion(produciis a
sho$ ihageorrhespineir.he middte
sone orflces .mx foorpfinB on rhc
floor or fooadn'l ro heb wnh rhis
nep.wedsingrcushion arrhebrseof
rhespinehelps!irh sir-downrypesol
(Askinsrhep{ienr ro swdtosorsuck
on thelongueandchceks.rbolhdu.
ns exp. re helps ro achieverhh
 rhrough.leadedgh$ windol ro er-
su'rihatrhepdic'rhr{nor ovcd!n:

Nor.: U youcrn rcmei,bcrrhs! [r.

Dun.e rhh lin rep make surc lrL

projhess,jewer.y_hckins aids rnd
olher r.tutn obiecr $Lch as sics,
chineburnotcosfronIo all nachin..
sc$ rhe sizeof ir'e paticnllor rhekv
sering Moi mrchineshrve .. lcN II.!h! 0106l!indgrtrhichnrc n.r
rhreedife,rir selincs br a chrd. rh e c liin r$ n u $ a h o b e s c rb y u \ irs e
i.mal durr, and Lar.-qc dtrLr Duins svirchal theroporrhemrchie. Fr:
the expo\trrcrlrcparemnnd nachidc
,hotrrdbe observedby rhe opeDror mn uiqE ro ,n machine

srcTto
3

:. rr|9ftun loil (urd ro ptdc rhediedrn:j

c0n$ruclionorrhcporcatain.Jlckd cro\n
b. siricophGpbde.en€nr I a. C a-pcnhr(lencenratincror)
b. silverilloJ pir re{o'?rion(lence 1

4 Bcndinsol rhecorie^ ofrheJitm

l. r. chrom.sb8lr (ororh.rrlloy)
l. Lcadcdgh$ r'ssnenrenbedded
in tos:

b Mchni. 0rted rrappedinstd! +

d Merrl fng,nEil y'ch as a bu[er ft.-

I rre is 6 ilro t t re ' 6 o t d . T h e c h it d in t rj3

r cd Sordpon rnd on noE Ihan5f bccauserhe enr.rls hrveetu:
I PorshinjfuLbr or porcet.hlu$d roqotd e d h ! m t rrb e re * ' h , nll )o \ u lL lb (! ! =
doreIhan6.b!!ru$ rhelareslshavebegui:
erpr. bulles rhzi 9.berause
rhctdcfits har:
norrrdfullycnprednori5tuo(tonnrioiio
 l. Lino'l r.don, rhich G appaientrrom Fisure I ?l silver poiDt and a sul6-
Iheractiharthe bireplane$en otrthi lilm is
!sed rocorcci rhiscondi.ion FiguE3-21-the ripof olleg€pliesusedr

Fisurc l-24-'ndgan. gold crsline, and

r. sreintEssteel*ir. sPlint
I Thh appeaBro be a yomg Palelr be FisuEr 25-an.lloy pani?rdent0ro tmne
!:use ieladvdy |{ge pulp enals and ..lF work.hat has acrylic pronhedc terh rhai arc
nrely gmd p{iodonhLrupponareevi.nr
r T$nna ro the anrerior te$ rcsDltd in ligure I 26-an luot padialdsnrurcframe
lDseningof rhc teerh,requninc tenpoftrv rork. pomeldnierhj and!01'l.a$ing
FigureI 27 ey€h$es (clr$ kn:en an']
rhc neidli. rr.nes for rhe lenrcs
Figure1 !3 Porulrin denlne rceft
L An ilon rtrbb.r drm rirn. Fig!ft I 29 rVne dof rncrure Edudon)
Fieure 3-30-an odhodonric lrtt.kei wnc
(ror rooth:eprturion). an'l anonhodonricband
l. An ivory No, 9 e odotrricdmp
1. Siher alloy retoretions Figure 3 3l-Bold csting, rcr)li. ricbg
5 The rip or tb. ndsquiro rorcps rhrt lere
(io! vhlble), and .rlculls (norcthc cacurur
adheri's to rhe sii€ival flea or rhe a.rylrc

Fisur I r2 r anent Dre, gold *rin8,

I r. Ldlcnl incnor rctosililesilvsrlloy
b. Canine gurir.p.rcht icthniquc F*urc 3-13-older.
I lr had an oblirentedpulp cdll and a coloredfiling nrr.ri.l and neren rrdiopaque

Fisure 3-14-.'i gou !noy, a ccmentb's.,

Fisuft r-15-gauzc, a suruE necdle, and

opcn.ft.€d slrinles ieel croms
FEUEEStt3|H|OUCH337
R.nember, ri.nen rm rron left .o right,
Fisure3-I3-pinnype lmprantand . por
elain lued to gold n*ed bndgc
Fieure3 l4-. blrdc implrtl lnd an:n.!
rhc iip oI nosqdro rorcep6
fi$re I 36 poi.el.in.rhenehr r 0ypaL
de otrtanbldeniure, cnenr, andrn r.rrlic
Figurer r? | rrcoB mrbo. inphil (nor
vnibk) wnh a gold pdst dnd an acrvlic
renporarycrown(no!'lloy
vhible)

Fi!trrc I L5 . olron rotl, rubbeq and .

Figure3- 16-a bii.-*i4 hb rn.nt

L Zinc oxide-eusenol lnd r.rmo_
Fisure 3 17 a relenrivc pin lnd a brukcn
bM rip, nos perr.ratingthe tooih. thd war

Figure I l3-a porcl,in rootb, r n$h

ro nrcdgthcnthe palatsof the denrrro.lnd r A ct!.iun hydrondc pulp cry rnd a temporrv
be&tll. pin lor ds dn.cior porcalarndenture

Fildre l-19-a wou3hl lin dGP Lr r.

Fisure 3-20-the rexill.4 sinus scPrm The p.rien. sutteredrmn emphysena,H. cr

rnorro bc confusedwith eidodontic mllcnars) ried wirh him a podableoryccntank$ilh i6
Fisnre 1-21 sult!'pefthe, a bokon frlc or tubingdlrhed. YouseerheimgeoftheplN

22i
F|EURE3-4| f6uRE 3-43
(n ure) Ma!.ral, fi L Porclrin lured lo nelll. The rype r
nertL canbe cl!$ifled as noblemeul allor:
2. Son acrylicnouth guardmdsrid wi.h rndbasenetalalloys, alloftrhi.h willb.nd::
rsoTMS pins.The*ide pin istorhe litrgual. ceramicrcnorarions. (Sccdble)
rherhinpi. is rilrcd!olhebuccal.Thse sere 2. Nlandibulafpotr
as nar*e6 lor crcs $ctional
$hich shouidbetakenldrallinpl$!parient. l. Maxilladrighrinci$rbo6r rprallf e
ver poinl oot oDal fillj4 mreriel rnd ncrdli
ftauRE342 4 Maii ary hn hoLu oo$n: ful ned
L Lrri cental incisor: tudiopcque roolh'
sloftd fllins mrGnd 0CFM)
2. Richrannri incisor:rrdioluror TCrM 5. Rilhr nandiblq malg,'n. vhich prob;
3. Let rondibularponric: goldind !.ryli. blydnppediniolhesock
a. RlEhrnan'libtrltrlortic: gotd
I R,ghrnuillary molartuor caml surtr. TharwhircLlici\cau\c
withinrl'eca$dre

224
 1.Ma{illarycental andlat.Flinchon: r!. 1. Sriinles leel ligrrurewncs ro lix
tacturesaid onEoromysurcicalhrsins'sed
I M.rillary nshr $co.d molar:rmrlgrn ?.1hose*hirc lincsare rheghoninrsc of
fie non din'r fig'rur. hre in rhe mm.
L Marillarylelt scond nDlar:rdioprque 'ight
objec( in ftonr of lhc rorarioncerer pro'lucc
4. Ma{illaryleft fisr molir: duninun ren. noghoii.lhe thirdwirewassuficiendypo\
rcnorrocomerieh' rhecenreroftufurionand
5. nandibd.r lcn 5crond moLar:silyer producethe ghoi lnlsc. The lons sreaks aG
poinr in ibe ncsirl n016, Suth.perch. in th€ due to rhc lacl rhd rhe thnd wiE *ar ve'y
clof to the rot.rionceme' wlrctorhe hoi
uonlal masn,ficarlon facror appmachesin-

r Themaxirrarrlareat incnorwr\ rcnorud

l. Anrlgm alloy itr the mnd'bdar ln! because0l a ders in dcdr!, whichi\ usuaLly
a$ociaiedrilhideeptinguatpitl. n renored
Rnh5ilverailoy.Toolhcoloredtitlincnrar.aal

sEcTt0
4

r. Auiqenols rEnspr'niof rhedevetoping

rhirdmd[ ro EplacerhcuBlnota.
2. Noridcrhef'. ncfir turr..esol bolhthc
sccondmorxfmd rhcrrt.sphnredrhndnoLar
Thisfia(eniryvasdoie]i ord* roaccommo
I Mandibuh finr darethe tansplrntedroorh.Nor de.aki6.
nored*nh anrrs'n anda cemnr b,sg eriononrheir\iJonhcsecond mola'rndon
r Thereis evidence ofsecondr!-deniiofor rl'c disr ol rhe ranspL'n(cdroorh.on rhe
n on benearh the mesialpurFrlRoo' Th. nesial and o.clusalsudac$ .r .hc rRn!
toorhF itubneqed!r Inh reipecl1otherdjr pl.nrd roorh.,ie5 is cvidenr Then n atr
;rnr leerh.The't n evidenceol.x.cnrlre. opsnconrrd md resuhanready signi ordc-
erptlon ol rhe rcot in ihe biin'. ion rrc!
\rh bonerepbccmcnr.Inrheseaftas.rher connon wirh raisplanrcJand rcimptrnred
periodonul ncnbr.ne tdh. th{e is Jmo! comph.erterprion oI
ipaces.sorhlr rheroorhtrpanrrrrysnklroled,.bc rools, and in $me rreasrhe r aiiins
of oneo$lerurn or Io.
el $l.rosiog o(mnyelilif ot trndercmined rhesud.undingbone,rl'tr\ iid icaring,n*!lo-
ris. The pulp .hmber appear ro be conl

I Heredtiory hlpohidru.ic edodcmlt ds" fl6u|E4 5

I Cteidoc'nbtdlrPlrrit
r Inonrin$ri, pignenri d .hondme..
nentn oi .hc tudrs,adcft.i.n.y rhrr nay id
\oDe way be conncclcd
wirh thc delayed d Supenumerrnroob in th. i6. ai:

nbsinspemmcnrmandibu. 3. Bcndibgorrheliln,Inoderrorc.onm.-
I Cmsenirdly
darerhclilm in lhc parienfshourh.rhelo$-
m.sial ..mcr N.s bN. rhtrs pmducm!:
L Aficdedchildftnapricar
nornalin every
other *ayi howevef,c!t!rrd! deveLopinridi

glruomr. An sicnofs]aucomr ii
'mDon![
rerdioi !orhcops.rorl ll$. if n ir .tulver Earr so far?co on. rher s more.
renrlydnededin lhencyes(phordphobia).

1.f,nrncl|,.ld (lnrmddh.i

l. Osleo.dcrosii(bone$ar)orroslelcro$
ingoteonyelirii(coidcnsing oncirisj
Nore The rinr o..u6 D rheabsice ofinrc!.
rion, whrrcasrhe ld ii a DroLileralive 1.StrpennneBy
re
sponseroarow.s'?de iifc.rbn.onciof putpil
2 Caidnels syndromelnd detdo{nd

Nors lhe lindingsof rp4ntrmcmry kd:

doesnot nece$olly in'pLyihd r coicuifti
l. "subncrgcd"roolh.Thh i5 dr. ro rhe
diltcrenrein hcishrberqeen
rhedcciduous
rid
p€nlnedr occlusalpLii* rd rlso 1orhere
renrionandankyroshof rhedeclduo0\slcond
moraraso.idcdw h rhcconsennarry mnsiit
:. Ddlinqene5n inp.rf.cra (d!nlinrl d\-

nlh rnd rehtiwh l€$ .irnel duc ro lhr;.

mu\edbyadd{rive de moeMmer jmhf
Toothbrsh.bdsion. r'he cbar.tckrnic fer
Addnionrlfcartres.norsc!nhere.
rcbLlboL:
r'Es arethesharp.rhr'. rudiol&edliie rosy oown\ wirh mmw \honcncdroob addRi
iis rhenesit'Lro-disral
sidrh orrheroorhin dr
cericala'.a an'l u dhrind v+hucd delecr
sccnin rhr ceryicalrhtrdof rhecowtr 'fhis
larer chan'.rerisric!nn b! vtuaLizedonly
lhgn ihe roorh.film, hd bcrm nc exaclly

I r. Rsdi'rionautng. The lJsc

b Prlp drcfierion in rhe Jinr rnd rc
c. crkurns in rhe finr and seco ntr.
nold. (Norerhs trnusual linearpar
'lrix!.-
of Bdiarionrtquituddtrriq rcarm:-
causedinrtrryto rhcdcveloping ft'r
b. Delayederuprion.Ahhoushradiatd
oftenhrsrhkefi.d. rherecrhu$L

226

snpenuft qrry hrerlt in.i$r
I ln .he mardibul$sccondFemolartherc
r jnicrn'r Esryrion, posibty duc ro a reac
lvc hyDerpldic pulp prcducingrn odon(!
dan'c resnonse. N.re rh. \c.ond.ry denon
trnderrhednd p.(ion of rhersoblion xnJ
po\riblcpEnapicaL lirolvemenr.i. rhe man.
dibularn6r nolrthere is comr creobtirera-
rionof rhe.omnarp0 ionotrheputp'lucroa
.eacrivepulp pmducinsai odorrobla{icrt,
$onse.Nolethedetedivedi$l narsi. dfrhe
L Oft $ourd rerr borhr.dh trirh endodon.
ri. theEpy.ThepremoL shoutdberearcdin
o'der!d renoved,e hyp.rrrlNicpulpbeforc
The molar ihoutd bc
t.dcd in ordfl ro rcnoveihe pulpbef.rcn.
chnical alres ro rhecanahand mechanica
mr.ipulatioDolrhc chrh becomAinposi
ble Thelauermodeof rherapyinrhissirtrarion
I h rhe mndibular nolrr r€gion
3.a. trxtcrn'tresolprionohecc usatrrea resorplion.especiaLly of rhecoronalind rpical
b Codplcte p pal oblilemrion
4. By ohcn,rion. Rcnovat*outdtJcdim-
cd.an'lrhoredo* notapperrobeanysi8nir.
i..nr aciivepa.hotosic
process r$o.ii.od w h
ther0orho. suroundinebone
r . a. The ror!ftn ot rhe nuridr .'nil
b. Thc nenrrrronner
r. Rapidodhodoniicrooihmovemenr. No.
lce rhat one or ih. prcndLa6hasbeenex.
tncred.Thc ncrrcsuI n exrernaroorrtsorp
nonresulrins in shonened, btunredDos
3. Oblncarionorrh. nulpchamberin rhe
premorar.
Nole rheabsence ofcaries
1. Denrin drsprrsi!, typ. r
rmus wilh nomll
b. very shon blun.cdor poi cd ndr
c. T4ered prunotrr in.ier roors
"nd
l. Hortontrl rrdiotmenr tiie!
s. rdiopdhi. p€rilpicct rdiolucer.ier
h. tr$ry roGeniog rnd extotjsrionor lhe
r. A ror{ed rishrcenratinciso.
2. PuFnore6inrherightc.nhtand tarral
r. Hod?rnratbonclo$rbourrherigll ced.
L HypercemcDrsi6
oflhe mrnd$uLlrri-qhr
rh,s h a horizonllrry inprdcd rnd Fo$ihly
misrdedroorh,r'hffe n evid.nceofexreflnt
Don'on\of rhnroorh. TheserreNapperro be
.nkJlosed.The roorhh tocared in rheonndib,
l. MefiodensGupe'nuncary ce rt in.
L P'rokny, The ctoscrrn obred h o .hc
fllm the moie radiopaque
n wi bc. compre
rheenlmelol rhh roorhro rheefamcLotrhe
I a.Bytakiis!hdiognphurinsrhen'\il
lary crosfire occlusalvie*
b. By $rying rhevenicatlisu tarion Gee
sEdion6, Bu.!al ObjecrRuh)
c. By va.yin! rhe horizonral
angutrtion
GeeSeclion6, BtrccatObje.r R(1e)
(nndocariont.Noricerhd rhr
Trrnsprsnion
permrneu ra!.ralincnor is missingand rhe
deciduous
larenl li.isorhas beetrexfolhred
221
'fbe permanenrfint premolarisen'pringinto Thc s$rypN arecla$ihedrcrd idg!0ei.,
thepositionotihe pemnnentla.er.lincnoi ogr',rhe mos lik.ly liolosy her berD!.1
anthehnouslcves of a nudional dclilicn.'

whereasin .iher casescruseis dclc.n,n!:

previous
radn'
I Frophylrdic re.tor.rion or tlr .r \ id and Riih the helpotahnrory and
I The pem.nenl hleml bcnoa lbc crnin.
aDdrhc sixl-c'r molsr. I he fi^r orcnol$ nil

2. Mdditulor lingu.l lori

l. lorcshoicningdue ro rsia rooneep.:

posniver ve{idl snslcor norhavil'grh. al-
rry pr.dolr6 or bDlh.Noticerhl rhecmwn\
planeofihe patienr! he panllel to rlr
arevell demarcatdby a ndiolucenrlinerhr! tasus
noor when thc nh *as cxrioscd.
represonc sncorrhr rccrh
$e tollicuLar
$ve^ you ve $en rhenbelo.el

2. thc piilenrvill b'nge-'sonclncsco:

L A double{oored lorer cnine
I a. Abmpi dininllion or ibe roor €nrl rnd rhc. yolu arily purse dl of lhe rGt
. cn somepaiienbresod1oLax ve abu<
b. Sererd smncr roor flnrl 5p.ces rs a mears of purgingj mon simply rhtu\ u.
subjecrinsrhc r!crl'rothepasqeof !0nn!.
rha.nimics rmt iiadure. civen Iheso nndil ii lhe !.id lion $c nonr.h .onrent e
findingr.one nrn todllzcrh,r \lvcml
orhg teerhin rhisradiosmph day have
supemunflaryrooc or binrcrrionof 4 Pennyolysis.Norc thc s.ulptured al
pea.rnceof thecervicdrgron.
the rcor crnal \Ftrc sirhii rhe \rme
Nore Allccrcd parienseven(u.llyhave.-
roor.Thesepo$ibiliriesare
'mponrnr ioraiive failures.Grerl bcncnrcrn be E
rainedby immedirorinsliewnhanuc'ds

L a. Exrriiil *sorprionn prtsent. Dir{cms, h rhh regiondn[L ro lhe caniner

logi. mndirion dr n libous helli4 de. splce h the PrimrY dcntiti. n onlY
led ita rcsc.rlonwaspe'formed.
: a Pmeriin jrckd mn
b'Prefabrjcaled$lcl..}Pec0le
Dildeniion. Norethe double PDM:pr;:

L Eighrrcen old,plusorminu: oneyear

2. EnanelhJpDplrrirjcnvitunfrcnral thid nolai
ryoc. h is thedevelopins

2. Enanelhlnopltsiaorrhe maxillaryaid
r. The nrxillrrJ and nrndirrular eft'l
I En.nel bypoplasis(Tfi$
'yrc)
2. A mi$odoil prenol!'
'nandibulrrfiFr
I A hoitonrrlly pmitioned m
'l.vclopins
.\melogensis inprftcr,, hypopla*ic smoorh
rype. afiec.ingborh decdrcu5 and p$mr
icni redh. iNole
well. did yotr ser tbrss an\wc(' wc hoped
lou would you kno\v you ve $en rll rhn
orr roorfomirlon is sonphrc'1.rhe.hr.er
oI r roirh enplins !re mrked! redmed.rhat
is no.rosay.however,thdrheroolhcannor be
iEdc ro $up. wilh onho'lonll!i crvciriol
I An imprded mrxill*y pern'rnenr€ninc
\nh advancedor complele roorfomarion
I Densin denlein rhc daxillarylneBLin
Amelo$neris iml.rredr, hypoplstic p -
L Ptrlpobl emiion,lt n |ocalnalinese/,
2 Therypeii.1isoftensec.ndarytotrrLml
in-
ncn( liirumcnrarioi or thc crnalE difiicaLi
I fhe iype in a is d\ua11ya resll! ol rhe
or the phy\iolodcaginsproc.$. Ar \uch, tr n not
I f,xtrulon ( pnenpriont rbe maxillary
molrr areextudedowinsro ovcrcruotlon
2 Thcibscngcoromosincnmdibularreerh
chronic periodonrrldiseas.mar-a\o .on
C.3, tsdnkclies (deeperthan Bl
D. 0. Sonndroothrrdurc
E. r. [rm* crries lNorc rhal .mm.l in
( trorobvious)
volvemetrt
. 0, soundru$odiionGlishioverhrq)
c. i. In.ipie.r.rries(very closcro lr
A. J. Deep reorenr eri6
C. 3. lirnk durent ciii6
B.0. We in.erpreredrhL
c.4. Dccp odu5rl c ies. (Note rharrhe
involveneiror enanelis rartLyscci
 B.3. rnlk reurenr.rrics. (Noterl'e L P€iirpi.,l cJdi pcri"pigl grtnuronr
'?di
bcncathrhisarcasbovingrhc rypical

of rheai.owFinri4lo rhs otrlD)

C 4. Deepre.nne @rier.(Norethrr re. 2 Dep re.um.r $ries Juc ro a
'lcfc.ri\.
Frrrivc dcnrinh presenroBineto the
alrctudsh{c ol thc p!lr hord.No!.

$mundingdenrinan'l.halirdoesnot
showliy peculi configu,arioi
) 2 The mxiltery sctond prenol,r lceric-

l. Theyan rhoushlrobc \c.oidary torh:

xe.oiomiabtuught abourhy Bd'arionntruDht
ofrho najor !M mi"o. srlivarysl.nds{
'hr
ax{rlion in rho quanrityor rhe sdivr. rh.k
Somdioofi nrdnrcr hovere..Dote apr!ssrolE somechanseinrhcqualiryorr[r
.onnent.Radiltiondoesnoi appearlo hal:
$y dirtct cfltcr on the hardnruduiesorrh:

4. a By operevJudrionotrhc pdcnr:
tdh. periodonliun. prio:
andatrirude
lo'c. a nora.bn \hould bo h ro ftdidlon lhcraPY.
'nad! b By imftdide extdioi of undclr
in Ihecour::
ablereethFriortoorearly

taining. in.ludiis inn'lction nr th:

2. Deep neri,l i erpronml crri$ s h d tsy Itoquenrdenralcheckt'psborhl

pnlp invotrcncnr,Nore rha! rhe cries hr5 rhc ca y nonthspiorrorhc lo$i61.
nrobrblyinvrd.d lhc ptrlp.bu n d.c\ i.r rerumof$mc $ lv!'t riov ard in rb:
lonEtermhecause or rhecv..prc:.r:
I Peiiapi.,l gmnulonq p8i'picrl .yil

b Pcrhpi.,l gmndona

I P€iirpiol .ls4 porirpi.rl grrnnlomri d. Periapi.llenenlrl dlsplrsi!li rh.6

I Probrblyanicoscopicpnlpexp0suredur 1 fte rnr ly rBr. Thc rasr.ha(r roorhl

insthepreprraiion or rheroorhlbr thecani4
Norr: u!ratrscof (hcpftxi'nnyolrhc inf.rior
slveolarcaml. rhis lns !o cutrci! !hinkins.
 2. The mrndit ut,r ssond pBnohr o*iie ri
L Ii rhecaseol.he nandibnh64r more
rheEarep.riapicat'?diottr.crr tesions
a$o.i-
aredlith rn .oprrenrl) cariousroolh.Nor.
ah. .hc 6iflrcatioi inlotvemem.vhicb my Probrblr 16. becaus ol rhe comparurtvcy
be asociaredwirh a hiEhtrrcrdlcannt.,rh! rargcI!lpchambes shosepulDhomsarerLx
bonesuroundingrhis roorhn 'lc.djve...a rvdy cros.ro rhesu'{a.cotrhererh
ii'criharhcviden.edbylheindhli.ctrrbcor.
Larpaftm atrdrhem.re scLeroric rppenunce
L Mraodonrirof rhesecordoremotar
1. Itr rhc orndihuln&cond nolrr rhcrcis 2 A slpcmtrn'en,.r, root on rhe nd pre
rhc incompLerc apexilicatioi!$ociard wirh
normaldenraldeleloobenrin a l2,yearctd

Norc rhe simiaririesbel*ed rhc rro condi

nonsand rherackof I dhrind lamiradun rr

Nor alio rharbecatrseotrbepdients agerhe

birufcarioninvolvemeir$ould moretikclybe I a trnrnel hlpopl,siaof rhc deciduout
ol purparo,igtirhanofpfliodonralorisiD.
J. canine.li'{ molar.rnd secoidmotaf
rbotrshrhisnd'ocraphrlone doe\ nor Jcfini
b coDgenirdbmtusinslafodonria)pfl
manenrnshr ceirml nnd lareruL
in!i.
sor. canine.md 66..nd s.ond pr.
L A lor8emesiduno6 kion, h h inrre{. c Exloli"redor mi$ing deciduous
!en-
ingro norerharr decid!ous(.crhbitu.dion
as. seq!elarocares is the rulc d. Dnrncl pea !ondecidtrotr\
'nvorvenenr
r.therrhanthe exccption.\h*eas in pffD[ e. Proninenrnuri€nr on|l5 in'notr
rhe 1i^1
nei. recrh * rheerceprioirurhfl rhanrhc
rure.conp!,e rhiswirhFigurel 61. llercdnri! rnhidbric .dodsn"r
.2. d*
:r. Tlnds en,ner hypopr,sir
werr.rhafr ir forrhc scriesoncaie\ andrhe
\equclae of caries.Burcmcnber if \omelhing
rhercnsin'nscrseprefn[rion\ looksr]ke
'n
ganes,don r rre ir otrr.b.caus!youknowwe
bxvea wayof rcpearins rhifls oncein a while
L r.Itistlerub.! pnlp chrmbcr n0ryhot.
oSyipuF non6imd miLdllllirion
I D.nrindysprosi!, rrperr

2. Tib rpp.r lip do\'ercdse)

] , A h r d u r g d il.i gledgeof r Yer. Hs hasan avuhed.ndrernptanrcd

4. u. A(r uaiedciu un 2. Relmspdc in rbc ,ruhed roorh

'natg.m ol rhe rpicrl .h
r. Enernal rcerprion
rhndsofrhemor of.henandibtrhrhn cc,rrL
mosor.Mh of rhc .cmanriqrhnd
Theprosmsis 'nr:yh.h
ldr rhn bo$ h funh{ comrti
r. overhrng
on themsiaror!h0 crtedbylhepreknceotcatcllurlnd il\ Fsi.
^mBan odonlxlinrlicirions ar rhc ssrvir. The lrlle
dianenasai the m.siaiaid diial rre unusual
i" rhi{ arcaandmnybe indcariveofnaringot FBion
Gyno'ionrism)belweenrhe dec,duotrl
lded ircisofanda supcrnmchrydcciduou!
llrcrul.Fusionis rheunionberpeendedrinrn
at lea* oneotherdEnral tissue.Thiscr\.,n.
r. rNion Gynodoirim) of rhc mrxillrry
dc.idudtrs
ceniralandlareralinciso^ Not..Thcdnrincrionbetweeifusjonand gem.
'lgh.
l. Prcbablyrol rheluseddeciduous redh. inaiiotrn onen dilh!ulrk enablih ina deinl
rve mann{ by aonc.
'rdjos'aphs
or odonrodasuperimposed on rhe crorn ol
rheimpacred maxillaiyrightcentalincN' n

Not th!! fusionin rhepinaryreerhis some Gcmin ion rschizodontism). ln eemi'ur i.

rimesasociatedsirh hypodonr olrhe per singkroorh emp6 rodividcinlor"! kdh
Thcrari!nrhasa normarconpleren!of cdh
Thiscon'li.ionin!dlyeronlyoneloothbtrd

l. ln them,xilh!- riehrccnrrtii.isrrhere
r ce$arionordevelophenr, *ilh imoopLe!. l. Hlper.€nenrosis. Norerhedenlinalod.
rootrormarion andapexlh cdion:roorn.acru'ei lincotlhe rool wirhinlhe cememal mas.
z. P4er,s dissse (olbnis defordmt
2. Ii rhcnuilllrJ letl..nrrt in.nor lperi.
ncrtun apFa$ complere.TheEtorc. roor fof
oa.ionmushavebeencdmpleledad inlemal
resoaroi sub$qtrenlly begun.Theren rl\o I
L A dilacolredooloi !h! darillarv.ish:
3, ln rhen,xirlrry rentrr€r'tindsorobtirer
xlion of lhc pulp chambs rnd roor crml h
naxiLlarysiius adjiccn!ro rho q* ol rhe
mariLLry6^t mola (direremirl, mdius

L PliDlurpurpilis.Nore rhe rhickednsot L An crupring

rourthnd*tdh.omolan
!h! periodonrat
membnnespacear rheapexof
rheneial roorof rhenandibulaffr6r moLar.
r Becausoor b'deriat conkmimrion of rht | . a Tte tooth h rhedbiil abuhenr tor rh.
purp,Nore rhc hcrcis!ft, whi.h k delin
earedby rheqe coidenscd amateam rhrr hrs 6. The !oo!hapreas ndiogr$hiclllr (
filLedtbedefec!clo$ b ihe mosialputpho'n

apeKifi.lrionof lhe prcndtnr ard slond

4 An cndnerpeld on rhentrndibuldhrr
nora..Do norconruse rhiswirha putnrone. An ]rconpleroly fomed supcmnmcrar,Ird
(h'ch i\ raELypsledlyci'cutarinshapeaid otr the mandrburrffr6t rermancdrnoL'
lEl)_ bdow rbe noor ol rhe putpchamber. lNote rhe lrse mor canal and wide opri
sincefl'dododic rhempyk inhinentj rhisis
ar ihponrnrconsidenrion

Am.logensirs inper&.l!, hypophn.

 r. c$e r. Note ctoselyrhc bonerhd has
hlledrhespacebdwccn rherwosegmcna.and
2. Pulpi.n d purpn€crGis rhelackof _readiviry_otrheryi.at trghrnr.
r. shrror dr Esordion 4. C'm]1,The reminir! tuornrlcrtrr 3p.
4. Ir'. rr.edr incisr pean soundand wirh endodonric rerrmenr
''uirr'ry sourd rfobablyruppoii a poi and o. anJ

l Dcnrinoger6isinpsf.d' Inpactd mxnhry ishr lint. sc.ond. ind

l. Theserecrhhrve strseprilrihJtu cries
abourequalro rharolnomrlreelh.
4. Osresen6is imperte.t!

No,Thn periapicltradiolucencyaduall),rcp, trn.ncr perd!

resensrhe superorope is ol rhs incnive lcnamelomat
canar,a normilanaton'clandnr& Thecido
dodic proceduretwercinirirkd as the E\dr
ofa fracruEol the crosi, wnh a pulpcxco well. ls simpLe rcdly Thc horizoibL!nsu.
itre (Noterheftucr'Bd crownin rhe mdio. ranonwas suchrhal rhe bifurc.rio' of erch
roor b.came \trp.rimpored.phdtrlins rh.
"tn,ner Nrrl Norc rhev shroeof
"iifrd.'
the peiodonral nembnne spices a\ rhcy
cfls.so$ im.rdiarcly benearhrhc rd l]'cr.
Ar anow ts rheren no cri\\.c.o$ineorrre
2. CseJ, Norerhera|3e rcnoftrion. penodontrrn'cmbra.espace3id no 1r
'csitr
\!hichhasserkcncdrhc1001h.

stcTt0t|/
5
f!!!!LE5,2
r. Benign,Noricerharthelesionis qel de
lineaEdby a thinndioprquel,De.Mrlignldr rientan'l hi{or} of fdtma rc hclDlulhin6.
lesionsrendro bc morcDoortydlined. vnL RadiolRphicJly,r|t resi.nn uniro!uLrrrtrd
norc rasged. indKinci borden.bu!lhn n nor n vell dclin..red.Birhr$remric bordffarrs
supeiorponioi. Norcrharrhcl!\ioi am$s
r. Rcsidtr,rdenlieerob r]5r
vnh ninin.l dnprt'cemenr ot rhe roor ,\L
4 BiopcylThis n mandatofy,snce dc.. IhouehrhelaDim dur G ono idi!d. id rr,j\
ugffouscyns maybc AsNiaredryirhor give
.\! ro a vaiery or odo ogenicieorlans I Pnlp len (.kdricrl. hor. cold. p..
Trearmeit.prognojs..ndlolLow up rre br{d
upon a deli.iriv. dragiosis.The biopsJrc.
leded .h:r tbis s$ rn rnelobhftomr, cavitywnh no liniq is found
'lh.emible
2t3
 I Ldsrl Pr 0ddol cln, Pimordirl trsr oonionorlhe bodvof$e nrndible.bero*rhr
ioothi rentrd g'rir (trl nandibukr crnsl and,bovc tbe inledor 'oiA-
The depftsioi mrv encroa.huponrhc ntli
srnub;L JnLlrn€l!l,lssricffhronrrhc l!n dibularcanaland/ortheinreriorconex
i"" l."io* trd.*odhv.
""c
occur in this agegroupand Ln
rheyalsoie.d'rcro-pcci,rv

L s'lpcnunenrJ loorh bnd md d"clolia

BoE n. in! r di L b u i !4 i r J
ts .-;:.ri"-. J' ,he Rt''in!d de'idtrut'ro0rrip \i'rorirh rc
' 'n("i
;; . , : ; ; . ,",
rbo\e rh! mr uhruJ r Llge Nolnr hr rh'
ompldJ! fr6uRE56

I a Amromicrdition lhis n trdikelv l\\ocirlcllwilhslpc'ndmell$'andmp]n..

snc! you vourd m' dpec! I pxr!\llle
si,rober$ocidcdwrhrnomdcaDd
aid sin.euponruiher*ammdbnrE ade d p d h . lo g Nmn d in d r{ . lA f id d 3
nsh! natulibulrr.anar\YA nonmL!n ujJ orotlunrogenn Lee
d.llnirely lncr.a\c rhe pGsihilitvor rd'
b Linsud mrodihuiar taijvar) ghnd de r.nce. dd rocodim delinnivelvrr d'n{'
oresion.Th( is trnlikcLv. sincdrhis
rleioi. aLrhoulh ndnlv lound i"
rhn ara. i\ usuallv beloN ft canrl
Thc rppFrancc in rhs rdiosrtrh ol
r[e saliv]rvclaid d.P'.sLor $ pario

. Mcbnrric di!e*. lhs a nranD'

sine rrsrhsL n 0 a$ociakdGnd L The.died n Probrblyl1'l r0 12it$
oninout \i!n Howevf. nddlc old (Do$iblv15voungasl0! o"s okrs L'
dhease wotrld nor bc so w.ll delin' Noticcrheopen4l.es ollhe ntidirr hf !r:
inrl n'emul r rnJ r!!nr moDl
d. Adenoidtydic oNnomr'This 6 po! ) Mc!rL dmldrDl Rr.inedruurirp! n 'f:
shk si,,cc rhe neoDLrmn'odr!.s
Darcdhesiabv prirEural rvsirn 1 No. Somctimcs
ih(. hotrever.usur!l! occud i" sol' $uDi\ wnhourconrLeietu\..ptionol rh' rdi
iisi,. conlainms s.livxrvgknd pdcn rip;or,heri,n]ry morn rhir phmo'ttu' "
rhyna nrher rhrr LtrcentaLbonc $merimcsseeninall fourquadranAotrii!:
? Aenisn irunl
h le l r J soo,l\h!tr€' vodd
'h'R
b. Dedlemsotu. neuronbroma. rno
r. li rav hale b.ei chaed bYr P;n'odii
Alwryr considcfa
.lnolasuPrnumd:rv todh d bv thecpirh'
vrscul.rksion ii thejr*\. csnccidlv l;r !€ns or M'l,scr, which trndergo i)!r:
a(thn anaronLc loctrion
l. YK ashilh 6 i0 Pfl {(brn M:_
'cm
kerdocvi r)F
sh!n il is of th. odonrogen'.

s ivrrv 3 aid deDres

siom;;Far ! ruund,oroid, d tilisursi l sidolih. .rlcilicd rvmph node' oieoB
or dFro!'hic c*iri'rM
mdiol!.ency ^rllt is LocarcdLDlhe poderior $lcilied thrombd,
in r softrissuelesionsuchr\ x heman9omr'
Do norlmk arrhe.nswerio pd l.l lraG nor t&es androo$ mobiLity wouldbe heLphl
l. r. Normalanlrontuvmiltion
r. a. By takinsano.dusll rica .rdiogrrph.
This*o!1d whelhcrrhc ru
'le.eri,ine
dloorny n locrredbtr.cdor [iluar 1o
lhebodyolthc'mndible.
b. rlir h noi locatd bucrally.rhc o{e
oma*!uld ben likelychoice.li cotrld 2. a.Ir the.rnincrcgionorrhemrxilh
be conlimcdby prlp&rinsrhenLnof
bo ciolrhe nandiblcandhYhioFy
. Ird,i\ opacityii dcdi!Lro rhebodyoI
rhe ma.dibLc. a srlos.rm \oul'r bcrp
ro whelhu.I rcrrctnG a
'le.emine
sialolithor . cal.ified $bmanlkr!
1. Ybr, bur ior ne.e$r.ily liom r sinsLe
rl'e hodv of pfliapicrl 6lm. Ho'evcr. hiL'rc'almultilo
d. ll rheopaciryis htctuLo
rhe mandiblc,a c,kihed thrombu\ .u|[ exp.nsilclcslonsinvolvingthe enlnc
mishlbc rhccru!e. Conlirnthhdiae miniliblcor Goi,cnmes)ihe ma\illr or both
may be considertdpa(hqtufronlc \isns of
e In the c.sc ol rhe hemrnliomr.rl'c .hetubnn Charetefttically. rheren rh'n-
plradoxi.rlly
llndin-a or soii $e dGcoorarioni\ nitrgorrhe conicaLphterrnd.
no kndencylor Darhologi. rradurt. Ako. dt
laycdcruDlionand n,alro'marionol lhc Dcna
\ore In lhir car, rheocdusal vt\r denon
jn.ed th rheop&ny*rs i'cdirltorheman-
dible.Theii.los.an sho*eddelaycd cdnryi'g
rimcand poolLnsof the ndiopaqF conhn r ft Dry be norml, Thn pdtd n otun
mdeial proximal to rl'c io'e the duds ieeninnormalFc^ons.csod.lally bd$eenrhe
showedsisnsolsla!odochnn. rh ch oftctrac 1006ol. matrdibula' fiNt nolar.
comp!tries\rlivary crLculi llnri dirgnosis:
sirlolirh in the rish. rvhrnon dud sDd!e.ond- possibi|nvshotrldbc lnvc{ilatedufiiL ir cnn
fiy sillodochnh ol rhe rishr lul'mrxillrrr bcqonnrmed o' ruLedour.
sickle.dlrn.n,l^
knownto crur alientidnsol.he tabec!lar

dDrinc!heparhogeneis orrhednra\c oncol

ther terationsol !h! trlbecula'prnem n
rcforcd tu as rhc \repladdtr-elled Sln.e
rhn paternn seenin dn i:Jiqnth. rhepo:
nun be inveiigdcd
sibiliryot thn discase
d. r_omll iD,ro.'i. Y'rierion

2. Ou mor likcly choicein thn ca* n r

nomll lndonic vei'tion or lraun,ri. oa I Focrl osle0pomlh bonemrruw dtred or

Feioddm5l dhcase
promine laminadurr is inadl ah.. rhe Nors Ths ibrous healinsdelectmthr be a
Fo$iblliry,hutrhisa Nua1l1' nof e Fdiolu.ent
Sde.od6na i1 unlikely. and nore eell dcfincd aid oiten Locrredin
ihe miilhry pFmoLar ^
andrnreiorro\
Eady oneosrcona is r posibility n'e pr Thc oncopoFticbonen.trow L otrcn
'lerecr
molr. region !t n
denasasc.5*, rndhnroryorpd' would.ho Locared in tbe mandibulrr
be helprulin esablishins
rh s clitri ken noi oftcnin middk aged \omcd In rh.
'liasnois.
pathosen$irollhil lesion,thelminadurr or
thc $ckd disrppclN,but the cxial bonen
morcrudio
iitaci Thearenremins rclarively
lucenrInd one' coi.rins frne,spane tr cduscofrhc l!.k ora lirc d.ri
'aJioluc.nr

Inrlr lxrfl u* ra
cdLrocondcnsingo$ciris

dniircrionbelwecnrhese.wo plinl$5.0:r-
rlonr ir impoflrd becauk {ledic bonr _:
orrhe so.ter lrer rh sreroricbonejbcsin' oseiris requne\ manascnent.usuallr I
.
n,,u rr dr baseof rhesockerandprcce.ding

beyondl|,e cunffnesof th€ so(ker

I . Peridpi.ll .enerl0l d$pla.ia rhe oJr::

r Ycr. Nore rr'[ rhe nn hasa htrLbou\ 'i
$lerosing 6reon!4
ris whcn mullirle

lucenri.ge nimics i pcnapicaLle\ioi dfr

paloricin-rhar n to sar,,a perirpi€l rbl{R

3. a. Thc mrndibularli6rpremoLrrh$adi-

b. The lim prenoLnrp,.brb!y hrs so

Dot, The signsor rhn re rbfupr
Nore Thislcsion'epresen6 oneorNo N-
ble peiapicrlrcacrions whenIho noor.f::c
m.i11.ry sinusis iivoLved
is ! c6e ol "penepi.d hrro lormrion Nn.j .
nor necesarilyr cyn. I! roorcscn6r deF.\
rionolreacllvebo.ebdginsimorhema!lL-
sinus.The orherreadionis kno{n s pe'n
11reproscns .hronic roor sleresin8 onsny.
elili! (cordennng
osreits)
(o.ationr thelackolconrinu1! ol!h! Itm
ln.dura arolnd!heapekorrheuorh
r. Nruco$ Frenrion.ysl or $e n!in-
rcsponscsolrlveoLrrboie r! rhcvnc nimtr
LusIioiec!se(Fig 5-17)rheperilpicJinrec
diltcrcnccbcrrccnr nucousrctenlioi$.' r
orhscrsc khisfurO rhqc wrr Droduqrioi
or
' h a t ' n t h e |a d e r. a s c lh e l] Us e B a Du |c i,

I oft 0$leosir(scLeNftboie) cysi re'r!ir6 no lredneni, erels perDpd

2 cal.ilicd $bnNillrry lynpb mde nmorjlis requner n'rnrgen'cni. nsnelli pq
 b. P.nlpicd gnnntonr
d. superlor fo'@en or rhe incidv. snd
t Fridordirl cJn of r nesiodens
2. Nor rhe obticmiionor rhc rcor .,nt
rpac.. This n M indjcarioror a hisrorvol
rhronicpaidc$ putpi.h.rhe oresers oirh.
remp.mrytillinsharriatiirheccnratronion
of rh. msn indicdE rhd M 4em;r wA
maoero drrrp.re rheputp.rr drvbe tudher
strnposdlhar rhir pr4ed(re wascmied uur
becruscrhe roorhsas toundro be nonvirrl
Th. roorhappedBro hrle6cenrenord rery
conserva!veryj andrhemor tiketyreasontor
rhe devetopmenr ofrhe peilPicaltcsidn*$
rhesubsequenr d.vetopmem orananachdrdi
puipnr andirs sequct.eAnachor.ricDrlDirn
ollendcvetops i' ledhrhar hov. beendevni.
I d RcsidDldcdhEouscln
c. clobolonorllary clrt
d. odorloa€njc denon.totd rnnor
e. Flbronshedins deaed
:. Thep.t{og|(sdrirsprce,carsedrhen
rhe palcnr raitsro placc rhe roisue fi,nty
asarnirn. pahi. !s in:*altowinq
Nore'lhe lesidnin rhis cas
s a re\idud rorlowine odiosmDhi.realures:
conpound tnturu ot rh. m.idibte
u. a Dap. odes vilh mdioeraphjcan
b. oblitetlrionot tn. apicutponioiof rh. ideRd ro hd!ee(c$Ne
16!0!.1spieH}I.^en.6il
c. Losofala!. eaof rherpjqt t.mhr th! trpperhalrotrhe mdiolmph|)robabty
dur 0d/or sln$ floor p€d,piot nu. rcsens a focal scktusins
Did yousern? You kne* rhi *as comin!!
b. odoniogenic n]r0mr
c. ododosdjc tcnioc}'
d fc nt st. re s,iutonr
Th. mdubtdon, tr rh! bAr rhq!!
_,
I ne rdonrogent(nJ$m, cenenlt, hb mrh
{m } n \ a n e ! ( s r p n s ib , h r,b. lrh e lo u !
rcs arc nrety rhis wc detined(inseadrhev
ror ro Fotl(e moreof ,he.\i[uirm jount]
Lneeugrsur rhec){ ,Jrherrrmnrhc ceDrrl
pin,irh c.trrlt
8i'rt ex srdon. iaEtv
cxrcndsftore Dojeriodyrhanrhepremori^
5. Pen'pi.rt ..nenirt drsetrsia r.e
mcnbnat. Thh co irionh in lhe oncoyric
ia$ In panem,{,rheconenrjbldi. nrreii
n.rh q ' 3 , 4 L ljh e md u € , , 4 e h D. rmr.
N-dc: In rhe mdre jJsc rhecmrrunJ .
otrencrescenr shrtsdi *irh rh. aDc\ oi ,hc
(oo'hntineinb lhc conG€ $fa;
rhc in
votred.lp* uuajly ct*,ty visibh md ihe
'\
eion tr surouddcd by a ftd,ottrce,rourtin.
L ll i{ a beni3n.emenrobt,ston!.
N!r. rhe
r. Radiopaciry6 obtirc.rrinerhs roor
b. Tbe edly terionappcnnro be d.tin-
clred by an p.riodonrltmem
b'?trcspacein'nlacr
soneiiear.
c. Them{u,elesio,,swdtdelinearcd hy
a pe.phcr. radiotucedrrui
,l fhe roorhapper( orheNisc no,nal
L Errnior,Thn mryinvotvcreDovrlof rh.
t orh.Thcselesions,alrhoughbcniF.arc.on
ctuurh oorentrrl
Nor.: The ftrnve y uFqf itvcoj hunem
rer_
ojeomy.tih *.
oioary ro rh. pen.donratdhcrr rha, \

Thk ons is p.n{icil ..me ,r dysplesi! lce-
Theprobable reason
torrhiscrr.rcrionisp.in.
rul pnlpftft (roorhachel Thn oay be thc cnuse
of thc focal sclcFsin! oeeomyelih:pic\cnr
ar rheapicalpoflionofrhc dhrulsocker.No
ricerheinrnd l.nina duratiniq non orrhc
previoudyheahhypciodonral{dus ot rhe
N.lce a slighrinrcrnpron ofrhe laninaduru
rrtherpi.alponionorrhenesi \dcker.'ndi
conncnr:Thk condnion n an rppared::
storsein heishrorrhedveolrbonc\.ri i
lhe dnhl oflhc ld nol$ ii rhe mand,bu:r
arch.This may involverhe tiKr. v$d r
rhirdmolar.ThererE rso sirtr{ionsitr\[:::
rhisconditionm.y bc Nted:
l. Ihc sirldion in vhich r molrr dAbr i:
rhc roorhin quenionha1bcci .xttrttd 3a:
rhe alveolarboic lcv.l d,n:r 1:
rh! rnainins moLarEmins 'nmcdidel!
hkh tLr,. i
ro rh. remrinderofrhcndce
2. Thr( in whichrhe molr. in qusin':
rilred$ the mesial.A pseudopo.ksLrif:::
on rhemesial.wh*c.s on thednd or rrn:,:f
sideanrDp.tonr "huild up oralveohrbor. -

localized
brc.kdovnofrhc laminidum Lrnitrg
rhc\ockcr.Theroorh*arextrdedbetorerny | trnr'rsedsdiol robcr.lcs
linher periapical
pdholqic conditioncould 2. Po$ibll.Norerha(rhc Dun.nrt
rulous. rhede.tu:c
Asrhcidgercsarh\.
Ir ir iotere{in8ro notethar rhe dArrl aocr *ouldrendrotdum iz. rhnrea.
appeaGr. havca' a$ogiarcdrhroni. coidi
! i o n .N hich iso n cnpal0lc$,*he'ea5rheme
sialap€r sas asoriatd with an eady a!ur.
rerrion.rhi!h is otci pliirtrL. 1. chinrilrldroohiBh.Norerlt fldocclr!
plancrnd rhecondyles v{y clo\ero rh. n-:
Nol.. Thh 6ho'nd .oi bc inrc'prercd s rhc
beeinninsor io.kcr 5cl.rDst,shich ui'5lly
doesnor cxteid blyond lhe conijilt .r rhe L P'ldoclosl rir spre. Th's r uu<
lbsn rhe Da!j. faik ro hold rhe rol+

:1.a Dcnrbcrous (folllculatcln

b Odo.togeni. kcn.ocrst, de g-.r.
Medim nrin*J lnredor dveolg cl.fi

Nule Thx cduldbe rn odonro3cit kr.::

cyi dueIo ih nodsare \h, ev en.eol.i
obsion r rhe crci of rhe idgc. dotrd! I-

molrr.Si'n muril rneloblaioma\.n\r r..'

Developmenrrl lin8ual nlndibu|lr srliwy ryn\- rly rargerdcihgerou!:.i
denti-serous
\houldbe s'\pecredro hr!. under,lo'c
NDre whci thn lesion oqrs in rhcait- 'b
iior areair ir nor spuciicor dcnii ve in ap The kenrinizin8 .nd crlolying epirhclid odc
n.. nc..TheboildAareolieDnol weLldcl'n. rosenic(Goilin) $5i is rs:ociarcdwnhr. *
nimic orhcr Ftrhologic .'rpred roolhin l0% orosei catroccurd !r,
rge or lNdrion.,nd mayhavccllcilic'l
'':
The rmgloblalic6brom xlnoi al$r\: it
Dhlrl nanilibnl* htpcroiosis (pseudohytoF cursin rsrcidion sirb an unoruprsd o' i-
orctdloorh Mde p{ cn6 d2 sobrecr rojl
fistr'c-htrtthcyrr tr\mllyabn youtrgdthar
19(iheale of rhepalienrin lhncn$lBhen thc
melobhiic nbromrnisEs
lThl{s{tln flcr addli[erous.ydaid$n n r
exrmpkor cyn.)
'vpicd 'h's

(unde.rheb' irscoo'ric)
Hlperososis

l. !'nn. did you rccosiizcrha!rhecircuhf

ntur p'i'rintrs.ln tudiog.aph
I yotroanal
r rherip ol rheno*r Ai Inr thr Lcstun
lsclf.
nreofiheksn,n5grorrhiin radiogriDh,
{he
a lmisire .rml .g (nasopala.ne
dtrc'

b. Prinordlll .ysl ora me\ioden\

c Relidtr,l.$ (liom a .enrnLinlison
l. NloCerare
ptrrp'robritenrion
e. Odotrrqehicken.o.y5r
l. Ceftflrom,ooseriehrcetrtnlincison
1.Iil,reBl Dulti.lobedmndibnr'r rin.
senicksrto(yis in .he mnilh lctrd ro bc
\malhr.soLnrry,
andin ihe aireior rc,sion j. Fon thc 5hicc of the udDltrcef.r. ii
\r!m: rharrhednraLoltbcdshrldcrsl in.imr

tudidhc.ncydo0dd rh! Ji\ralpo'rioi oi rhe r. oieomuriJi4fronthe w l of rhem.x.

c'o\enorrher[ird nolarinxofien$e. in rhn

2 No. Th! ruoc n.w w.ar ro br ruLy

rormedirhusrhe roorhi e privepor.nridn 4. SiNlorh nerr rhe paroridprpila. rhn n
s'eailydiminGhed. Noricet'Lsothxrrhc.oo.h unlikely-sin.e the px'orid prnilli I trnLal!
n vcni..lly impicrcd*i.hrhc $o{n ir nishr adjacenttolhc mariLLar! i6r molar.*hich i
$n radiosrph {ourd

J Soii ri$ue ord60rion in rhe b!.cal

1r PopcDriledllor orh$ fdligi hody

(periodotrro\is)
b. Juyenileperiodontis
Thrisolcnftlenedroasr-.loDdy|iout,and

flobrbly a$ociard srh rhec,fiousli^lrnd

Norc lnfecredrccrhar noralBaysthe.ru\e

of r doldy sinus.TheDrosr
commoncauscola
ncc olrhe p.licnr andthe lorarionollhe 1e clotrdysinusis chronicsinusirn.Paradoxi
sioisrr.claslq. Nolcalsoshd uppcr'i rob! c.lry.ihn hrfl coidhrodhayoftcnbersori
'h e b e gi
clniie. nmareln
This n g o r b.ho
NhS.onmonly
onlhedLu|oflhe
iieded lit'onernoltencdloduDonroruleoutrh.redh
as rhecaus orrhe paricifs dr$omfon Thc
 torusmayall be histolosicallv ldenric'r'd
DreEnccornuidin fte nrrill*vsinus maybc is madc solelvtrpon r[ecnnra
rh. dislin.tion
,econflnedbyiakingfteWare6 sinurra'rro presenorion
qaDhicvicw and by hnnlludinriion or rhc and r.diosraphic
L Pauenr.of Me\nrn AmcflcJnrn''
5umerimes prc\enL!' h thesho!cllhapedd -
sr sandmne. Thc t*o nain llrure\ 0r b
*nd;mc re rr, brunedJnd .hrrcmd tr ?
I Tbc lesionin ndioElPb t
;RJ rod \. FnKUlml) 'lror or henmJt_
1 i 'the Lesionis aboui? cm in dilmder Ln
borh ndiogoph i dnd ndiogriph ndee\ oi md\'lLarY in(FoE rn h ' i
' 'he
i; rhe,honei,ncrnr bluntinsofih! mr
radioPaqm nltnd 6
rdiognph,4, Ll'brlsrFQntl pcmoltrmtlrhc mrr En ir
oblirerarins lpicesi at thc sage psmd$ Th0sn tds dnnpre$$tr rnd E
'oot
shoen itr radio$rph , nd'opaquc m^odibulnsecondp'tnorarMs nol b'tr!;'
mrlcdal nodobliteraGsnor api.e\' sorbedby rhendiopaquelesiotrithisrsms:r
re *nh $e behaviorolo$eo$rerc$s'
bandor ndiolucenrm{.ua! sunomo-
in! the ndioprquccore signili'nsan
edy lcsion!.r rhe nlgc sho{i 'n
thereis a thin but di! ct brnd ol '' L Devdoping odon.onr
'a
diolncenr $ eial sutuundingthe
diop|que corc. signifyins. malu*
'd 3 No.Thehktologicd4no* mayortrfrr
seve,alolher aliemariv* Fnd, rhe rei'Y
d. The roorh aficcted in mx y rc lb e mo d d b ma d $ d b [ lmla ' ]
,4 nandibul.r mold- L ihe mon
lesionSecond. lhe parholoE_1
conmo. rire ol rhe lesion;the roorh odonrogeni.
afiectcdin radiocraph a-mandLburar rd mry . o n irmrh r ' h ! i5 d iu L lo d mr. L !
secondmolar-is a commonlocfton F A\oojed \irh o'h!r prhurosr nforr=-'
amclobbnomaoreventmalenj
e. The toorh appcarsvilal ndiogoph! suchasin
lesioi.Allof rhelepo$ibi|niesaltecrthep"=_
canyin boihA $d t
nosis. rddiiional teatsem. and folow u! n
r. Thc roolhin n appoasro bc exh'deo
dm ro (heksion (nore.ho$ever'r[rl !hepalisnt q:
Notethatrhtrreion a
lhis h m unusmlhndinernd rh lhc ,'rL n'.v. .
bv r ndiolucen(lim This !
exrssionmY beducio rheabsncoof d;mrrared ':
ofdl odontomatespenlr
rlr maxilla'yrooth)iin A rhet Lsno conn.nt redlie ar_..;
Sucha line
roorh dGPl&ementbY the hton (3 de{elopinsodonromrs 's
sul.muR:
featuieof aninvenedd.veloprns
xrv tooth.d well asorheirud'opaque knr:i
L Benicncunenrobldon. inihisfigurel\r':::
! Rcm;vd or.he lesion-dd. usuallv.of Thus.ono!hingrhelesion ma'dibuLai::
dtlv srr .{eoschmsn; rcrcanii be a
rhe roorhas sell A thc tson
rr. Are youshningto catchonj
Nors Yotr my hlve nolicedtharbothlcdh
havepdp nonenanincidenr nndi4.butm'
trstrdfor rherse olrhesePar.nrr. 1. a. Corrjl.cme ilyinsfibrun!
b. ccnll'l o$ifting libronr
c. ct'trl cencn.o_Nsilvlnglibrom
I On€o$lcr6isGcicro.cboncl d. Benjsn.eft nlobhsloma
wcll !e hoFd youd eei rhis Note lhat rhc
borh is vnd xnd lhrr rhere k Do ddiolu.eni 2. Anv onc of rhc ff6r rhtee choi'es li!:'
lift above.;s rhcvareall relarcdandhave\ln?
'idinearinsrhescledicbonciromlhesur
bonelocidcnbllv if vousaid chdlrtEd$'cs
rcundincnomaL
Thn bsion *as in rrd I ednr cn.}
oi4m! yd wdld be pa'ilv tuh!, as one Ndc rd_
omr- exonoris.enoio{s, o!eoscLetu$s. ana ftin( nbronr. A promincorrearurer: {i
like sn*rh Dar@msith a resuxdt erpansion handibular6ri and secondmolan and oi.
of the buccd md linsual codical plares and
dEplacenent of adja..nl r*rh. rhe apparsnr The bdne has a "groud glrs" appea nca.
roor re$rllion in rhis casei a bh unusual. and.hereis no diiincl hminr durr in .his arca.
ksion h well delineatedfrom bobe.

d. Donimi cnnio.mdrphy$d dys

a. C.ldlyhg ep heli.l odortqenic runor oI

b centrd enenrifrmg, dslBi4. or

came o.cdfyinS libron.
c xcmiini,ing dd cllcitins odonb8enic Seondrry hyp.rprrrrhymidism. this condi-
tion resllls frcn increased
r.nalexcEiionor

e. An.loblslic odo.lonr ofcalcium.ThisninulaEs proJlcrionofp!

rathyroid homo ne, *hich re! ults in incrtasd
Nore This s.s a Plndbo4 Innor. Sone
learuEsoflhh rumorareits asocislionvnh $cre.ionof cdciumh a sequrlaof.hechronic
iqraction or r rmih thd is nor u5uallyin_
pacted,ndiop4ue necksresemblingdriven
snow, expansion. lite n ol thebuccalcoi ical Ihyoidhm. rhc $rum Ca lcveh seen,n sec
platc, and poor deline..ion flon bone. ondaryhyp€rpdatlymidism de oien normal

Nolc rhc "ground glrls" tabecular panemrnd

Conpler odonrone, REhcmbci cooprex
odoDtonas tendto be no$eior in enherjaw.
shsc{s compound odonromas tendro bc lo'
catedin rhe maxi[a, antedorro .he nd molar.
Donr ser discoungedl Thh is a soodrimero
rhe generalEd los ol rhe lanina du.i. Norc
d$thalrhemoreidvdcad gianrcclllesionon
rhe parienasrbht side(radiogrrph,4) is pm
ducing rmi resoari.n and exrdsidn of lhe

M!.our retedor .y61ot rhc nuillrry sind 2. a. lo$ o{ thel.mtm drn

c. Cotun rool appearanceor rhe alveo-

3. Chronicditr$c sdlrein8 dleonyeliris

Noie Tho rakincof ! headplate m'shr hclp m

b. Chronicdiltue $leuing oieony.rrri.

trtusicls or Gleon' i! the diasnosis,Ercisior (froid ose.u: dysplaia)
in orderro avoid inrerferencewirh ihe nand'b'
ul dentud is rhe rEatmenL niop.y $ ma!. 2 Chnnic dlttue $lcGing oi.omyelldr
datory for confirmarionof the diagnosG. 3. Node (as lons

l.Ir is a dcunscnbed FdiopacitysuF

rcunding the oor and periapical aEas oI rhe Chrenicosreomyeli.isor.h. left n!.dibl.

I x GIn \ oi.omyttiiis
r. ArtiDnni.s.Penicillinn niI lhc lnus or
chore inmoicr$s. lhcanrlbnni\ J'ouldbe
coniintredlor I ro: weeks
0c^i* ro' severrlmoreBeeks.evcinotrrh\.
Resolurionun'rLly olctr^ sithr 3 to 6
momhs.Notcrhaiheoffendins roorhhr bc.n oof rhe pmrlr crlcilictli.sion:. Uixlll :_.
I Denriserud(rollicnlan
d. oKc ol rhcjs osurrinBin l'$rl .cll
c. Pshp;.,I(Re.enirepons'nd'c!!erMt
somepeircisalcyi\ rYbc oKa\ )
tndins ro{aRr trr
b. Sullopedbordcr.
d Displr.encnr or
e. Mulripleclns ('n somecaft
g cloudyrumen(milky.wrylumen)
r B$rl ccllncvion (heskin
b. Odonrosenic ke iorJ(! rrrheiaw\
c. aiFd bixndorhffskelelaldctumit cs
re.uncice rate ol
OKC\ ii 50rur cctrr{ithin 1 ro I yers
Nore:Recurences atu sdd ro bc morclikeLy
whentheodonrog.nic kento.yn\ (1)occurx:
rxn ol rhc bril.ell ievus syndmme: tl)are
hrse and mrhiloculnrandpedorxlciib \ofi Nore.We re \ory (o fDr.fl d[t \e n.
li$tre: ud G) ntu diliculr .o seprnt vtr.
girulLynaii rlr bonernd reDdro rcqtrncr
s,Drimoo:cd on rhc lnrfif hodef or rhe no hnloryoitruma orhs rhin thr t*':i:J
242
b Crkificd lymph iode
Nore:Thisvrs r cdcinedlYnphnode,
I Pkcc a No. 2 rtao.al n1n*lrh rhr r:-:
sidc lgiitri lhe buclJ Dtrcosa.Hrle rh!:-
rhm hold {h. lih wtrhhn indcx0ng.r ii
k v rre d u re d ! o lb o u i6 0 rd rh e mA \ rx c t : '
2.a Oieonrcu . Thc deDsiry corr::
and !h. rcund, smoorlr'r
dtrim.
b. Milirr! 6eomr. Tlreserre ofl.i:-
dens! antl Les vell dciincd:uttri '
rhcf. n a md,oLuccn.cetrrefrhatf:l
ducesa chnrrcre|nrcdough.trL::-
lesion.when thes. o!$mr\ .r.--
howeve,.a v.scuLar
leion L tr$-
chrracterislicl! rh.r: :
p,tsen1.and
r . ioluced componcnr-trsudl tr
(anda
sevsal nitr or'adiolLLcanr
J Ctih.msn, fhe denily is corcj
hlLfslrge tlainsor rice
e. calciffedr.neorsnrllpox$!s.Th:<
lsnon\ nreusklLYndt so radiopr.t
nor rrE rhcy { weLldelincdr
..riphoy an ntusuld otrrlinr
'i:f
much morc likcly (Aho. of rot:r
clinical$i'ieice orthescabtr rt<a
-
lf you s.id buarl mmosr.you r. rb\o L::
ns h r. T h eh lma is r lie w o f t b es o f i! 5 ! u : : i
rherdjrcenrbur! rnrcosarhe pa.entr
of {ome deciduou\tcclh rharhad beeD::l
A hfiory rourd obviotr\lybc of bcnctlrThis
couLdposibly represeni a hl8e andgm e!
rooii rhenaxillaryruberosiry.as wellas$ne
otherneirlic ohjed in rhc,n!xillry sinus.In
rhcpariemreveared rharshehadshor
'dualiry!
a .r2 cariberrevotvg inlo r sink.The bdter
rcocheredbackand irckhfl inr|1.ficc.lhc
md'oeraph showsrhd rhcbtrnelenrerdatthe
marillrry rube'lsny,kavin-smm! fl€menr
bchindr n finaLlylodscdin rhe ,haxillafy
I A qio' rtrbede!orCt (.da9
l P,rienl Flnioncd roo f,r ron&d in the
l. Plh.qlosal,n lprcej causcdvhen rhe
parenrlbils ro hold rhe r.ngue lgainn rhe
Ii rhe madibul.r lefi Jimrnolar_caricsis
prercnr. f.{.rdron woutdbe rheobvi-
^[or-lor trearnenr.Th{e rppcax,
ous choi.c
however.ro bc .n cartybfictr ccmcnrobla:
toma ai$crared$irh rhc apexor rhe dhrol
rcor Renov! of rhelesion$d,consque, y.
of ihc roorhis re.odmended. Thisis b.catrsc
rhe reson day achiev.r lar$ :ize and n is
s.nerallyimpo$ible ro separarerhe lesion
Nore Thc difere'rialdirgioshqdutdindude
hypercemenrosh. However.hyperccnenrosis
r rurc rhisagegrour, *hereasrhebenistr
'n
comenrobranona doesoc.trf 4 rhisagemd
thenmd'bul fi'{molarislhemosicommon
rocatotra sbonpe'iodolobrRarior miehr
bc in orderto secif a m.r rypiclt tcsio.dc

I M.ndibnlrr noh. !rer, Thc clueheE ir

5. High okitrn hr.kej suppleiienEd\rirh the'nremalobliqueridse*enon rhetefrofrhe
ironlrun and/or sodinn fllonde
Nore, O$eop.rosisi: now rhotrg[rro be L n. Petq,icrt .ens
causedby a rone-rerm ncs.rive.alciumbat. 'l
ance.Thecondirion responds !ocrLclumrhe. b chro'ic diltuse
.py. The nronliumandfiuoide helpro nrin
bh thebonedenrnyin lftecrd parienh

l. a ccntur girnrcsllgnntlodr r. using.bcradiogliphatone.$h n I difii

b, B runor or hypuprmrhr_roidiftc!lrqueiion The .large!tiko..
apperr!n.eof
c Ancrysnrl bore.ls rhelesionswnhniiopiq!e ceniers,atongwnh
d. Dolinophili. snnurona thc hisrory.nrcnsty su4*h peimjcd ce
e. centll y$olar lBionslhema.lioDa) menbrd$pr6i. in rhemartrr.i4e chron!
f. Mrlignrn.y. strch rs pimary inrnL diai'se scl.rcsineonconyeLnni\ oosiblc.
ho\eever, aid hasa pt'ltkdion for mtddlc
4ed blacks.ft hls beensueeened lhrl rher
2. CenrErghn.mIgnb omr.Thebigdtrc nvocorduonsmayh f.d berhes!ftc.
The oneomaai<l bonescarare nor u\u y
rum .alciun t doic ro ruls otrr hypffparx delineard bv a ciu'm:c bed ndidrenr
thyBidnd {hen a hhtololicdiasnoisorcei.
hlsirnr cellcnnuloman ftceived.

l. Thc mrirluy riShtm.dor rcgior

Periodonrrldise^e; gingivd .rnircm'; e6in.
ophiricgmn'iorli n.hna.icc'Kinoo'
NDte ThG caserlmed out .o bc &lvanced
2. Then'xlrr4ryrishrDemlnen.qninc
r Foliolsr.!st (dcnriserous
cy$)
L Adenondoid odonrq.nic ronor (ad.

243
 d. Chronicdifius. $leMing ofleont €l-

: ConpouDdin t
':d'ogrrph in(.$e ii boncden5ityar rheexpe6. oi]

oieoblaiic fundionh.botrgh|o be doa

I The mlndibuhr lelt lhird nobr n in- sirh thc abnomaliryarTec.ne
rheosreod:.1
prdcd wirhInlk eruptivepoteniirl.\inceroorNorein rheishr nandible,the cofle: ci::
foharion .ripe.n .lnoj complEte.The seen ro rre diiin.lly involve'li rhu\ .-
apicesofrhe rhirdnoLarrppcn ro bc Li iui Buch.m\ syidrome
Anong rhethrte remaini.gchoca\. rlLoi:a
osins.oan in.eiiurilionolrhc$Lpcnor&ll of bonesolrhcbodyare€rely lfleded b\ rb-
rhe canal.Othefsignsorri rnrina.eElrnon dGc!sc5.Thc orherrypeor o*eopeton. l
remed the recesivemdtnanr ryca Inr: 1
(l) a norc Fdiolucen!lrreannc.olrhc roob maybc scv*ely.fieded evetrar bnrh s:.,

or.grdov. in (hcrco$ ccaiedby c osecron Sincethecondnionis rccc$ivc.borh0& l

imry.r rhe cdal. d (l) nairowis or rlie nu $ c a t ry lh e c e E $ d p a s iro n . T h e v ! o r i
rmdinrheEgionwheE irc,o$srhe roo.. a
s-snof. dccl stuovcln rhs ruoh crcdd 6y I He hrs blen rold ro nloid $iadr.:-
becaur of tbe al'nos ceiai" pos'bil'r\ -a
cantaft.isseendinalrothe.rovn.sumund developine onconycli.inllhich wilt be \:-
i.!$n G a widf(ctccit-shats ot\dc- dimculr10tcar and mly bcco'hclir. rhrti
^nu
follicllar sach.s bcln loi. and the zoneoI
rercrivebo.eninclor pf.xinny h rhcitrn s,med ro bo r stn of uncfieckedoneobrdi
acrirb, Lvhecasthe eLevared EsRn 2 ior:F
2. Ch$, lr, y.niclli shs Il becrurerhe
fccrionis in bo.c- ind boncin|.dion r$!:-
in increased oneoblanicacrviiy Thusr[.-
diandef of lhe rhiftl nohr and vsriclLlbe.
dn'l *vcriry Boic idcdlon\ r$ b. ri:

3 Innrnnliory plEdenrd .yn, ThG is a

jm:r'
I P4ef\ dhes. i\ r rudiol.eicrll)_
rologic,llyd.n!ic.l IorhcpeieicrlorftdiN
hrcyn The sotrrce .r innamnarion n !i in quenllyinvol!edrhanthemudible.whsn:1
feds'l operculum.fhe indammarory ndureof
rhe condnioi h fored rdiolo-sically by rhc
b.nd ol reaclivescleroricbone sutroundinscnusorrhc high$. hvch ofllkaline nho5rr
thislesion.alrhou$rhisferlureis noialwayl
rhld nold is rhe
.oothmdi Irequenllyinvolvedisecond is rhe
mardibuln{.ond molir.rDdrhndnrhemrn.

lfyougidgn'givdml.jnongtrsqnmD[<.1
€rinon!, yo!icrishr. Thc hiioo nr\r!=
a. o{eopehsn. doDinmr beDignrypr
co.icd tlpcrost6ii (vin
b. Generulized ''florlins roorh wnh a Locrlized_(pe:
BUchen.\\yid'ont) Nhichha. |!:
ou( rea in lhe alvcolarbonc
 rig.rcu)cy{r nd $s rhereAonrlr B.
c D
L HypcrNt6i5 or 0hcotfl bonc bcnearh. anaI rno!rd/llirenr;rd r!no$.
.
2. Odcopdrori. botu nrrb* deled
L roreisd objar_aciualy a broken $r-
s,anmsruned !h4 r6ained!fi*ienoqt or Iryo! e'd detetupnorst n3lrrs,ljrsn shd
ier npacred.h'rdmolff 25yeaL e.nier 0.pr6ioi. vuuarcnshron'14,he ( ;mi

L Thehfirhid mot$ hasa nonatfo icutq If lou sJ'd L lide Grd{r.ruif

iacj vnrch on ponoraEjcmdiostuphsmay comeisdg odcirti rod R 5ide:
rtost scretu\iiaojeomv
her.ure up ro I mm fl rs lrrsc{ Lli.,mdcf otr'n. vouaft(otr(r. oneGltcmysir
ryir decenemhon d4.
mayhreoc!uftd on $e pdh,crnd $en in a$oci.1iotr!nh vnalrderh:
righrslde.If noint crionispresenr.rhediaeno cuidensinE on.irn R J rc4ch\cnrc\cjs tra.
$! or denr'scouscy$ i5 D c a,d hhrorori_ , rj revning hon p.riJprcd,n[,nndio,
c y mnhmed by or
presnceur a mm;r
rnncdaf sc o'ce 'he J hrnotoarc d:!n!ns of
tuhr tb icut,r\a. h mad.. hehnJrLtiasi..
n\ (es ununrh. rtdiosophi. inDeJrrn.ctr
hr follieulJri. h .r Jrued.e,p€(irt! J. i . a. odoniog.tri. tcmt*si
comDared roorhcrdeveloping rhirnnohs. rhc B P.inordirr cJst
d'rsnossordenrise,ouscyn Gnade.h n our
on'n'onrharrhc parhotosnr cannormrke rhc Noki Ttr'. ss dn odmb3Mic rrnhs{.
d'atnosn of denliscmus cyn wnhod rhe m qno drn ooq\ prdeimceffqro$re;h
d,og&pbiconvenely.rhedenrkrc.nnormak! rnr nhu. nrhq rh:n rhehud, d ,hc mJoJ,
ri^ diealBs ,irho4 rhe p4hotos\ rcpon de l he K,||Uped !mtrdeLl mJEm\
aR (Di.
cr Mo . r p n mu t t id r. , . , \ (u ! * 3 0
F.;;Lr
'ois 'hdr
m,) caua 4n appeumrcc uraren. :E ododoFnn |eDtucyj\ An Jmelobtd+
rcma rhe srme terion *ould have
mofe
IrrhrE\innanni"o,dde rodoocrerr rh€ i,ernr'n ii(uriuh 6nttmrre c\ denceor.r
dA'hr.f rheerupkdm,'ndbuhr sec.n.imorr. prn Dn . z n lrjlp ilt y . , rre h k riu rn { m. f
rhen rhe diasnos( ot innanmlrofv.vn r
mde nd conhDed hBiolosicalty. Thc in :. T h qh A ro , Jo rrh i. . : ( i iro , c J t rr\ o F e
rmm{ory cyn is. ar rhisrimc.con\idered! acirirorh.c.. rnhom, iJd olnnh, E
Yan! oi .hedenriserous cvj in Ir covemsoand excc$ive in ns dosc 'mn.Lt
o,
I Thc impacrionsare ctr*i6ed asfo o{\: rurd un ro'hend'ienrshen(lmtrftd roDJo.
Lcn sd.. ck$ ||! ne6io{nqltri nahrrd€ urrmr ruriotosl Ncwcrmr!h,n$ unnp;r.
cJnh mitrecn mmbm,ioBMd rdk c4rh
Frm i rr. Jetns a bu,e mrrctr do\c
pmlm, c h t q Dlf u |h , |o r|' Ub { c " n 0 r' L rD.
o olrrnhsulns E \pe.d hrn md rhetoi!;e!L
ansur.trcuieAddnioD r. ncqerprno,imtr
macrrnes sucn.sft e phitipsonhontixsD mi-
b. adcmnaroidodonrqeiir rnnor . nri:f donhfzdix projechiFond4
c. Anerobtlidc ffbo{dodroms m* ! h o \ { t if
d c_rtriryins epfihdid odo osedc cln ,! drm'nd.J. o t c o d \ r p d d , ma [ rt f l. ' s
of own nudhs h?f \ho$n
0rrcrRs\a' bedd{rJ on gmd Fmmimtr
e. crr.itirg .nd t.nd,nhs .pith.li.l Eorosaphs
6 seI ason bnewinsrhs. orhgf
odorb3.ni. |lhor (Pindborclumon sud,es havc sho*n rhar ,Morahic r.djo
:. This las a ddrigerous clrl. Wha! is ;n
u{d tr rhe li'r e crtc,fi.d ne.k qrhrn rhe smnn s , B * u o d d , n mz p (d rmd rlsrn h i
rcrrE 5r$mM, orbom he,!h ii
rumrn Suchc,tuhed neck. :re mc in den- mr cnoLloi.
drcd\e Addirionrty nuior:mx i,Jr
 sraphsmay show o.riapicatinracriodrnd ricdo\ewasmea{rudart31pc!.T.dr\ ! :i
of beamJilrftrion
vr\s. ow4 b.he romoxriDhicened or dose rcdtrced b!,10pd !cnr arai onrm.:.i
orhd lmt'eeprop{ric\orrhepmolmf vtt* ^
3 04 rCJ lh ir f t rn s G a rrh e ln l] n o u f
KcrenryI co'rcLrjonber*cenijrtignanrpx vey ddive s 4l rime\ --.
moreradidiontr : .
n'bri.!h ltand !h.n do.s rhc avn.le :r-
oim'r rdosrtLph.ln flcr. rheibso rdl;ri
, , u lr . {di no 'e d rhqinferen.eLoirh!r i.L rorhe$btinsuxlgirnd
ustiErheNr,tru \::,-
vicw was m!'sur.d .r 69 4cy. Tlj6 Lr.i:
r h ed e ld o p fti. ofrhescrumon riof owf
ptrhrished dnrauc found rh.r rhe lh\o|bed naled 41.44c! rhus. thc dosero rhe.
doserolhep'roridstandinrhcnrI modh sur lisorrsr,nd durng rher t-horlh
!r^:.
34 r tim.: !'earrrhai rhardelivcrtdhr :1
wh 7 3 rinesmoE rrianrheabsorbed do\s ot Mo r VeAxvi.w cmoramicnmdrii! al
r0 Fer cenrofprotiJ rumoh irc mr,g:rr
ihc pamid slandlrom the n,ll motr.hn! vev lrfl ca:90pe'ccnrofsubLingu
sArc(nrft d byt,bom500p{ed byusi,grh; slindru.
ronsrdnngurrf !on..Ii ficrj vrr!n rhelone arevcnererlsrLk.wirhlhesc,ldrinnn;
w?sufd. lh! n,l nnuih \ r isusefL,t10considerthe noftnnchxchii:.
'rcr.nsdar!one
veydctiverdonb 1.3lihcsrheab:o,beddo\c rh!liNchoice Jbfc{minirsrx[entru
.J ri.averugepano'nmicmachine rlr: j
rvc judied ,es,peiodoira diiease.Derari!rlinncr:. .
hve rmornis machincs. and om mchine.
rhe Mo,ira vfl\aviev. ddivfltd rbout \ir
rincs le$ tudirroi ro rheNroud dind Lhatr
thervcrige or rhr hvem.rhifc\. te fe sn ,nrtufd rrd'ogrDh!. indiv
u,t ,adiogrr:
mrhine in rhe \cr!eninc.tiiic otour dflrtrl
.chool.compred h rhis na.hiie. rhc tLlt rRefercncs (r) underhilt
fE. kimLL \
moudrs!rvey u\in3tr spcedtitD dclrve,s3.j chirva|q@fLera :Rrdiobtotosic
iim4 Do,c absorbcdradratnm skenr:_
ro rhepa,.r,l
sLad RxR eaahtill'diotrhrs beenaJltc(]kl c id e n . e . n df x 1 , . o ra t s u 3 . 6 6 : 1 6 t .r5 r
rhcbearn.whichrrducesrhcprtrdrnn,.ndi.. c) unde$i TE.
chilvarquflt. Kmmli :
.on by a rhnb. 4 n* .flr wilhourrtr,tnr al Rrdiobiolosic rak cnimdion r'rcn,t. :
rddiolocy.Pa'r I Abso6cd do\c\ b rri:::
Fne xndri specdnlm Thc rbR 6cddoseiJ o rs rn \ o ' rlS u r. 6 6 lll.
t 9 3 3l
3J94Cy,\yrs14rime\no(lhanrheeni dd
60.6ecri drliyerd by rheMoiravcarvFw
we incrrtred r0t pcyand red!!.d rhatnstrre rfy.u \aidplorid.stoti_wc.J
besuhn\-r
by40p.r( b60.6/;y wnhbermhtu2rirr Bd rha.s $hrr $e! w{ct ti rhe n,Ar,-!
thr rtrlrdourhsrncy dosero iho srbman. a'ea.rhednrrcnlirldiagi.sis
inr jnrtLrj
dibulr era\i ir 2 f .imessrd.r rhai ro rhc

i \ r Tr m estusr h anrh!inraorrtd.\.Rnse
r!bringualet'ddthe do* n 4.0 rime\grure,
rhrnton'cDrddusinsrhcfL nolrhsurcv.
nhcrlas rh. rvffagc Frnounir doscn a i r
tr{ tr,ncsles For rhe $bL rstrarglaid rhe
do! lnr rrrcfullitourh su'!!y !s]ns rheloig
recaDluhr coie aid E speed,itm vu\ mea
ntr.d I 14904c}.Forih.ryeDg. Danorimic.
r crr.ifcarionsynhiirrNsubrl.Jon.
-:
Notc Remcmberrhar s:r .utcoforid rr jr
tnd ro be nuhipte.smrt. rnd somdim- -
diolucent(mu.otrsptLLs)and mmdibutlr:.
culilendnrhc sinele.ndiopaqr. ind lrr!:
 sEcTro
6
L An emndona Gnanelpcrrl) It ir ringml,5nd
*eic sureyotrknowrheai.
rtshourdbcnorcd rharmdiocEphr1wNtaken
in !h! lsual. presciibc,l
narner a rakcn
"a\
*irh rheconednectd towlrd rhc.nlerior or us rhesLoB te.
the arch.The enamclped appeaE.o have p$enfs As you!1zc tromthe
movcdor shiftedto*ed rhedisralo.opposirc letr ro dqhr. th. (own of rhe,oorh
movesrron beitrgsuperimposd on $c tcfr
b thednecdorol fio$ ot rhc !f.! beam.
rei k d rro L h eris h j. e n ' f ! l c ri lo u s e eL h r, l
'Iheer.re,'he rouihmo\e,.1
in rhessnr djE.
The inractd (hird molar rpp.a'\ ro hnve {prlrrllr. No$ ir ruu re!cre jhc pturc_\;nd
$iited lo*arl rhelnrdorolrhearch rirce ir slze to'n nghi !o len. you will mive.1 rhe
overraos rhesecondmolar.You rre corecr if
yousaidll is locrtd slighrlybn(rlrorhc sc.-

oncealatr. l@k dn thepariedfs Lenside.rhe

B-B is rocoredber*ecn|he ccnrat incison.
Thse is an exr|oo. on rhefiar mola'. h\ Now gazero rhc palietrtsrishrr rhe B B
ro.,led buccdly becausen h$ moved ro rhe Dovesiowa $e prie.fs ten. as ir i5 now
rntriorwi.h.hs iow ol$e bernr sup*'mpose,r on rherilhr cenr!tiDcisof.Dtd
you saybu..rl? Welt.youre.i!hr ti fnd. a
llreEl headtiln rcleatedrha! rhe B B $,!s
Remembflthcn'lel llthe objecrnov.r in rhe
sanedireclior$ $e notr ollhe x ky berd.
the objed h bu.callylocaredIn rhiscas I
Compa'r!hc sizeolrhe inp$red ranif. rorhe
.otuarareratcn'prd canine tt de6nnetyap,
reatr hqer. or haa fied, Ir n $erer.E ro
card b*ir,r rhepaldlrlside!
we clvc you rhe answershcn we srid rh. well- thars n. No* yotrte Hdy tor rhertr.
rmalrsirvera oy hovedlo$ardrhc 50urce of s*e' \ ro RevieyQueiio4s fo. Narioral.nd
ir.,.Lingurll! n!h! staleBo!'d Examina.ions insec.ionT.Cood
'i'nadon.nora$aytrom
 stcTt0lt
7

B r e.i"i n t.bsrprioD prublcnr

RadiosmphA:
A. rmisrve6d or inci.iy€ tonmeb
D E|Mdom. GnJmelpearl)
B. Ir.l6ivr od.y!l, Noretharihe appeaF
.nce oI a 6diop.que outlineis a sue !igtr
of cy$ic tansfornarionsirhin rheincj

B. Aner03en6nimpened!
2. D. Pderoglosrl an spr.e dtre ro ronsue
l. C, Ries.l:yndmde,ducrorheposibil
ity or .onsenrialcaraEc6,rhederec-
rion and danrsemenr ol whichcan
help prevenr blindne$ in affected
2. A, Effi:iye posllve vdi.d rigut.rion.
Nore Thesisnsof .hisaredimensiond
distonion-i.e..loreshoreiincoI rhe
buccaL mor anddongarion orrhepat.
ard rcob-dd superimposirion onhe

L A. Diri.m. Noretha!rheprimre space

B. Denlin dylpll3irj ryp€ I
oc.uFonly rheprimary dcnririoD.
'n

B, n's r l(.rd psiodonbt cyrt, bur I necd

io ho* ir lit d odonrogenic rer{ocysi
sbtlTc (because rhcreis ! coodchance
of recuiren.eandI needro rule oD h.
basalcellnevussyndroneif irnanodon
.ac€n'cf,enrocysrsubryp.l
2. C. Prlrr,r-notic. rharrhe radiotu.ency
movinsin rheslmed;ecriond rhe
^
L A, Prvions orthodon.icftrtuqt

r. A. Pdidt bo rlr roNed

l D. Softll$u.ou ineorrheno$ c. Dev.topmdr.t lngu.l n,ndibula. 5.ri
r. B. Ghoi inr8e of tle ftyoidbone r.ry gl.nd d.pKion, pod.rior Erisr
 ) c st@nd*r hrpe4ri{rhl idnn 'rr
$ s ' u i t r ih \ i\ s h ! m
Nd. : rh , ! D; \ d
$hnh !n!u rL -
'n
the *vere {oion
havecaused

C Paltlll N.re tbe obviousrusnricruon

oldt naxilkrYlell cdinc

D Priiirl de nre left in D rtltiErd rlmrh ordE

F c.tron rolt or bfte suidc ior used | o t.| The!Lq!\'

I Cenhl qirnt relr Snndlomr' Nu e tnd

rhc*run Riciun iudies m dom tr ruLe!u
rDs
b\Drmrrrhr'orLlAmshen i lrn'ulo-!! 1. C CkIi Ddar.
h io'J fc )Ptri Noie lDTrrnsp0silionG].$ocllon]
Ihs ksioi ,n,l
'h\ tro'\in!'he mdm mu
rhElocrrtunanteriorl. thc fisr d'orrA3'a ar nGUnE 7-30

\ rulpiun€
B r, cml $tl oI n6'l losr B loorh{olortd lillig mtrenrl
c rmdg'm €noddon
D In.emrl ohliquu ridge
Thde.re no rr(hes tor rhe rv":_
F Fibnu5 huli4 dttid ohtittft riae ntJ | !,d t\ht'emr
dt'r '
C Gutr'Peithr ^t
H Rrdn,Prqle entrior rcnon'Yt DtN'
u Th. lerd lpron blort{edrhe bc'm'
ab'
n\)nrD .f iN hirt .oat trrd rdi"rrd
ri:
A. Fibrousherlingd€red Notr rhd
crninc n cElny mi$ing {'d thd ri'
ch$ni. iiflrhnario' could arGenf:
thc obviousoenodon( disc'k 1tr l

rhctu xreno malche\br thc rcms rfprrzr!'

ddtr'.'/ddr'. aid.rfl(J

in'isorsf,ndDnc A. Cleidocmnialdytprrs!
D. Shorel_shaned

252
 l. D. chln Doririon.droo loe
2. D. To bdrer yn!.rik rh. .nfru .nd of. 2. A. To betler vi$rlize rhe nrrilh. Thc
mxillary amcri.r reeionbecomes s-

L D Tongnenor .3!ir ih. p.lrls

t. B. Move rhe prrienr br.l
I C. Crin pdirioncd roo hiSi
2. B. To be(er vbulid rh. nrndibrc. 6pe
ci ly rhermrh bealingaEas
l. D. orher-|ne .lrinss wde lcfr on
2. c. Ghodin.8s rmmthe bn aning
L E. Toon!.h IVD or dA
Fnh .m lri ror $reer u.d
Not€:Overdcvelopmcnr isa rareoccuncnce.

l B. Prricnr pdiio.ed roo Lr br.k I B, Ghod h.g. of lh. on rhe t.fi

Com.nr: The signsof rht eror aie some. 'pron
timessnbtle.Th. incisorcro*nr aie widene'l: Noi.: The realiml8e or rhe mron n jui b€
I he dandibular anrerior.bei.s behindI hemax neathrhelererL. Thslirnebtackdobrrc rhe
illa. tuzzcsout lnd rh. mor rips .d cur orT {nchnarkr along rheedseofrheapron.
becduserheseimcttrres aE li0surl ro rhe I C. A rigsruF*n. roi rhetrednenr or r
laysr;the shdle prrientbecomesroo wideso pErio$jx* rrelurc
rhathc condyl.s snd rumusato very closero r. A. Pdierl pGiriomdloo frr br.k
or dfi the edsesot the fihi rhe oandibular
€mus fallsbehindrhecenreroltuldion.rhus
pmducinsrhc shlrp hoizonril !r.ak in rhc
poseriormandible rreabilatenllyisomenmes
rhelurbinatsaresprcdolr rro$ rhemrxil- r. c. Hr|nr.y bdc.n rheprtrht rndbnc
cd sideror rhcmiltr
2. E. It k nRcr desinbleto so posniora NorerThccanineis ridcn.d sirh resp.crto
rh. orher$ruclurcsand rhe conrdarrrl
caninc.This indicares a pildal posirioning
Addirionally.conpar rhesiz.ofrher{o mr\
illarycenratin.hdrs.therishroneisquneI
L D. Poshloill8 lhe pdle h the slunp.d bit ridorrhaD$e len.Thismeans. il a[ titc.
lihood,tha[he imprdedcarincroorhir o]l
2, A. Th. BIor ihl8e ot dE spine arllra theoor of lhc righrmaillrry cc.ral
L B. Pliclilae ll Ge.d* n or.di.placedrhercolofrhemaxilar,v i'
Did you know thar rhere w.re so many na 'nc
c'sorrowar'trh. buccrldd rhusrhecro*n
chines!vdil$le in lhe UnilcrlSrdcs?(1991) ofihrcentmrinci\orroqardrhelinsuat. Thras
The Panelipse h chmlderhlic $d \hovr rhe shy it s so much derlhai rhcdncon rhe

L Thc screenk labclc'l wi.h rhe machins!

2. Geusd co8 liies aie oftedpresenr in A. P{ienr pcillon.d too lrr roBrrd. or
rherishrsnd reftramtrsareas,in rhisca\eon cols.j ae knewyouwoul,lgd rhiir
rhekn ride,andaE se.n.s venicalbindsor

1. rhe sideguidesh owprojechvenicauy

on thc hhiand continr theRdod L. c. Dsnrindylprrlir,ryper

253
 l. D. Nor rhin rhe inrge lo!.r
2. D. Boryoid odonrogcni.tysr 2, A. R.srvesiponhDeosry

Nore Rememb€rrba! objecb bmcal ro the

imagelayerbui $illwnhin rheimdsolrycratu B. H.redi&rJ cdodemd dyspl$ir
projcctcdinterio.lyjandlinsurlor palrbLob.
jed\ ar proje.tedslreriony.

l. c. Dlnng Far 2 oI lirc

Nore Remenbe.!ha. lhc cown ol rhecenhl
iicisoa idenrifiesrhe ase durii€ shich de. 6. B. PedrphrlceDcn.ddylpt.ri.
velopinsteerharc ilTecred.Trie i'char thid
represens yearl, themid,llcrhndyearl. and
theclinicallhirdyearr ofrire.
L B. Abour 12 ro 14y.!r$
2 C. Supemuncruy premorlr
r A M3ndibnrrirbirdmobr L D. Juvenileperiodonritis
2. B. Mdxirr|q 8nd n'ndiburrr premotrr

C. Andqen$is inperledq hypopla!*

6. C CodponDdodDrldnr
 au.4l@7-5s OErdon7_6!)
A. An ont.Edioh.nc, obs@ rh. !!le c. ft. .bonsd.ftedpt of. shg. roothbnd
lo divideido Mo r€erh
Au.dlohr-56 Qw ion 7_70
B. A nftllh. mdtoprqocirrgc A. Th. utrio, D.M.., so eD.nr. roorh
bnd..u\ualyb] d.nr.ndndinsd
Qu.rnort.sj
c. Norhni!3 rh..o,gu..3dIn th.ptt t 4t.stiM7-r1
B. pemr..linrn .rytoi.Etir.ien
tut rlrtu7_sa
a. Morenbryokidionofth.hxna..b, ltu tdor r-72
c Pcn.ne n.rdibutrr prenok$
aDtanr-st A4$iM7_73
C. Plrie.t ms podtionedtoo frr ton&d D. Both{lrehsrc !r. hue
olBliM 1-60 O@rtion7_74
D. Pdh'nh he€dr$ tuiltd *nh rhe.hjn c Thiit.,tube purp ctEnbc6 .nd odr
snE
0wriM7-6t a@3liDr_7s
A. Th.r3t6r thlg. or rhetpins ih{ ir nor B fiie phFbbgr q.,nhs rsrJ of roorh

gbdiNT-i2
abdib 7_76
C. Pdirion.dtoorrrtoMrdorroofrrbrk A. Thc prrhotqE*eairng.rr! ot roorh
{tuchE hyr reic .rt prmss
alu.dlonj_63
A. Pmidonldin ! tun.ed or tih.d podnon ltu.dio, 7-lf
Outntu 7.64
A. P.ridr rc Fs ionedroo hr b..*
o@titu 7_1A
at .lioi 7-65 a. Mesioderr
B. Cho&6r, 2, .nd 4 sc. diEue.rerot
bhcfrms ihe BdognDh Ou..lh 7_79
oErlitiD,_56 D. C{i6, frtrnrj nd .ulod
c. Aflolfh.croias.reprundside\et
iry au.nin 7-.30
D. vr{Ury onh.

B. A[ choi..s @6 fx* cm caus rhn 7-Ar

condition '*dtd
D. A[ rourtcaionr
0t tltat7-6a At lliut A2
B. M.rll.ry ps|mdr t lht b.isoF C. EEpriotrcyd
arettion7 u dltstion7-sa
D romi4' *doped m'qinberhrsi d

ot$tid 7-35
C. x4 d.moriBre ndmpequerc

atetnot T-36
A x i\ !ndorsctobd norr
c lhc i'{! iecoodimd lounh rh0nF -:

D Trr€ r rmdrrd perirpirrlrL-,o'..'r OrrJfioi7 rO,

QtesM 7-33
C. I nr. n.{ v{h'Dd rrdoprcr,et
rnm endinL''ion 8ndfteEPr ir

C. 6-1?no hs tu$ on7-io3

A The tus! llire (hoicd a'e coftct

D. And bo.h e*lEdion O!.t on 7 104

C The tun .hrec de coned
'hohes
B. A w.tt{onicrr.d '\eenhrough" rrdiolu_ a0rlaior 7- 105
cenc! c. Thc nd ihrcc cboi.e6ae corec(

ole.tin1 92 Au.tnon7-tO6
A, Dcvclopmenlrl li4url nindibulni s"ri C rhe nor rr,,.. cmrces,," .omgr
u!-. slond dcpre$ion
Q!6Aon 7-107
txttdion 7 93
B The ff{t lnd bid choicesare cored

o@td 7-103
En*tid 7 94 D. All rour choic.sare corar
A Tlle 6rn tbr.e choicesare comd
ate.tinl 109
drcstin1 B. The fid, rbird, aid founh choicls :-
C Msdihdrr pn'nobr !rcr

at$nor7 96 arestin1-110
A In.tive cmal.y{ B The nd,nd thnd choi.eraft corccl
A. Tl'e 6nt ttr* cldq a. @rcd B. Th. &.o.d, n'ir4 0d toEth .nde e

A. Tbe ff'3t lnr* .loias ee 6ftct

D. All ld chohs ft comcr

25€